Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática

Resumen Introducción: La combinación de dexmedetomidina y ketamina, conocida como "ketodex," ha surgido como una alternativa prometedora en anestesia general y sedación. Este enfoque potencia los efectos analgésicos y anestésicos de ambos fármacos, reduciendo sus efectos adversos individua...

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Autores:: Calle Alvarez, Elsy Sofia
Campos Carrillo, Maria Paula

Tipo de recurso:: https://purl.org/coar/resource_type/c_7a1f

Fecha de publicación:: 2025

Institución:: Universidad El Bosque

Repositorio:: Repositorio U. El Bosque

Idioma:: spa

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repository_id_str
dc.title.none.fl_str_mv	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática
dc.title.translated.none.fl_str_mv	Benefits of Ketamine and Dexmedetomidine in general anesthesia: A systematic review
title	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática
spellingShingle	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática Ketamina Dexmedetomidina Anestesia general Dolor postoperatorio Nauseas y vomito postoperatorio Escalofrio postoperatorio Delirium postoperatorio Ketamine Dexmedetomidine General anesthesia Postoperative pain Postoperative nausea and vomiting Postoperative shivering Postoperative delirium WO 200
title_short	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática
title_full	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática
title_fullStr	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática
title_full_unstemmed	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática
title_sort	Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemática
dc.creator.fl_str_mv	Calle Alvarez, Elsy Sofia Campos Carrillo, Maria Paula
dc.contributor.advisor.none.fl_str_mv	Mendoza Obirne, Mario Garcia Cespedes, Javier
dc.contributor.author.none.fl_str_mv	Calle Alvarez, Elsy Sofia Campos Carrillo, Maria Paula
dc.subject.none.fl_str_mv	Ketamina Dexmedetomidina Anestesia general Dolor postoperatorio Nauseas y vomito postoperatorio Escalofrio postoperatorio Delirium postoperatorio
topic	Ketamina Dexmedetomidina Anestesia general Dolor postoperatorio Nauseas y vomito postoperatorio Escalofrio postoperatorio Delirium postoperatorio Ketamine Dexmedetomidine General anesthesia Postoperative pain Postoperative nausea and vomiting Postoperative shivering Postoperative delirium WO 200
dc.subject.keywords.none.fl_str_mv	Ketamine Dexmedetomidine General anesthesia Postoperative pain Postoperative nausea and vomiting Postoperative shivering Postoperative delirium
dc.subject.nlm.none.fl_str_mv	WO 200
description	Resumen Introducción: La combinación de dexmedetomidina y ketamina, conocida como "ketodex," ha surgido como una alternativa prometedora en anestesia general y sedación. Este enfoque potencia los efectos analgésicos y anestésicos de ambos fármacos, reduciendo sus efectos adversos individuales. Metodología: Se trató de una revisión sistemática de estudios sobre el uso de ketodex en anestesia general Resultados: Se identificaron 17 estudios relevantes, que incluyeron diversas cirugías. Estos estudios compararon anestesia tradicional versus anestesia libre de opioides, destacando la variabilidad en las dosis y técnicas de administración. El uso combinado de dexmedetomidina y ketamina en anestesia general se asocia con una reducción del dolor, menor necesidad de opioides, y una disminución de náuseas y vómitos postoperatorios. La evidencia limitada y la variabilidad subrayan la necesidad de más investigación sobre los beneficios y riesgos del ketodex en adultos. Conclusión: El uso combinado de dexmedetomidina y ketamina en anestesia general se asocia con una reducción del dolor, menor necesidad de opioides, y una disminución de náuseas y vómitos postoperatorios. Sin embargo, se requieren más estudios para respaldar firmemente su uso.
publishDate	2025
dc.date.accessioned.none.fl_str_mv	2025-02-14T15:55:20Z
dc.date.available.none.fl_str_mv	2025-02-14T15:55:20Z
dc.date.issued.none.fl_str_mv	2025-01
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dc.type.local.spa.fl_str_mv	Tesis/Trabajo de grado - Monografía - Especialización
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dc.language.iso.fl_str_mv	spa
language	spa
dc.relation.references.none.fl_str_mv	1. López-Millán, J. M1, Sánchez-Blanco, C2.Current use of ketamine for the treatment of acute and chronic pain. Rev. Soc. Esp. Dolor vol.14 no.1 Madrid ene. 2007 2. Gillian M. Keating1 Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs (2015) 75:1119–1130 3. Ykeizumi LC, Correia da Silva R, Villar e Silva G. Combined Dexmedetomidine and Ketamine in Pediatric Anesthesia: A Brief Review. Anesth Pain Res. 2021; 5 (1): 1-8. Correspondence: Lilian Satie Ykeizumi MD. Anesthesiology Clinic, Marcílio Dias Naval Hospital, Brazilian Navy, Rio de Janeiro, Brazil. Received. 2021 Jan;10. 4. Liaquat Z, Xu X, Zilundu PL, Fu R, Zhou L. The current role of dexmedetomidine as neuroprotective agent: an updated review. Brain sciences. 2021 Jun 25;11(7):846. 5. Hou M, Chen F, He Y, Tan Z, Han X, Shi Y, Xu Y, Leng Y. Dexmedetomidine against intestinal ischemia/reperfusion injury: a systematic review and meta-analysis of preclinical studies. European Journal of Pharmacology. 2023 Sep 29:176090. 6. kahashi K, Yoshikawa Y, Kanda M, Hirata N, Yamakage M. Dexmedetomidine as a cardioprotective drug: a narrative review. Journal of Anesthesia. 2023 Dec;37(6):961-70. 7. Rayyan - AI Powered Tool for Systematic Literature Reviews [Internet]. 2021 [citado 12 de marzo de 2023]. Disponible en: https://www.rayyan.ai/ 8. Elsaeidy AS, Ahmad AH, Kohaf NA, Aboutaleb A, Kumar D, Elsaeidy KS, Mohamed OS, Kaye AD, Shehata IM. Efficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis. Current Pain and Headache Reports. 2024 Apr;28(4):211-27 9. Gao JW, Lin MY, Zou QF, Huang JL, Cheng MX. Effect of small-dose ketamine combined with dexmedetomidine on emergence stress response as well as postoperative pain and Th cell deviation in patients with cervical cancer surgery under general anesthesian. Journal of Hainan Medical University. 2017;23(8):75-9. 10. Strickley T, Smith K, Ericksen AM. Dexmedetomidine–An Alternative to Midazolam in the Treatment of Ketamine-Induced Emergence Delirium: A Systematic Review. Journal of PeriAnesthesia Nursing. 2024 Apr 1;39(2):311-8 11. Duarte-Medrano G. Dexmedetomidina, tendencias y actuales aplicaciones. Revista Chilena de Anestesia. 2022;51(3):265-72. 12. Sahraei R, Ghaedi M, Haghbeen M, Jahromi MS. Comparison Of Ketamine And Dexmedetomidine In Reducing Complications After Laparoscopic Cholecystectomy Surgery. International Journal of Medical Investigation. 2023 Jul 10;12(2):154-64. 13. Ziemann-Gimmel P, Goldfarb AA, Koppman J, Marema RT. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. British journal of anaesthesia. 2014 May 1;112(5):906-11. 14. Zhang Z, Zhang WH, Lu YX, Lu BX, Wang YB, Cui LY, Cheng H, Yuan ZY, Zhang J, Gao DP, Gong JF. Intraoperative Low-Dose S-Ketamine Reduces Depressive Symptoms in Patients with Crohn’s Disease Undergoing Bowel Resection: A Randomized Controlled Trial. Journal of Clinical Medicine. 2023 Feb 1;12(3):1152 15. Lodhi M, Sulakshana S, Singh AP, Gupta BK. A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia. Indian Journal of Anaesthesia. 2023 Feb;67(Suppl 2):S126. 16. Zorrilla-Vaca A, Ramirez PT, Iniesta-Donate M, Lasala JD, Wang XS, Williams LA, Meyer L, Mena GE. Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2022 Dec;69(12):1477-92. 17. Berlier J, Carabalona JF, Tête H, Bouffard Y, Le-Goff MC, Cerro V, Abrard S, Subtil F, Rimmelé T. Effects of opioid-free anesthesia on postoperative morphine consumption after bariatric surgery. Journal of Clinical Anesthesia. 2022 Oct 1;81:110906. 18. Menck JT, Tenório SB, de Oliveira RM, Strobel R, dos Santos BB, Junior AF, de Cesaro MP. Opioid-free Anesthesia for Laparoscopic Gastroplasty. A Prospective and Randomized Trial. The Open Anesthesia Journal. 2022 Sep 30;16(1). 19. Dey S, Kohli JK, Magoon R, ItiShri I, Kashav RC. Feasibility of opioid-free anesthesia for cervical rib excision: A case series and review of literature. Journal of Cardiac Critical Care TSS. 2021 Dec;5(03):208-13. 20. Urvoy B, Aveline C, Belot N, Catier C, Beloeil H. Opioid-free anaesthesia for anterior total hip replacement under general anaesthesia: the Observational Prospective Study of Opiate-free Anesthesia for Anterior Total Hip Replacement trial. British Journal of Anaesthesia. 2021 Apr 1;126(4):e136-9 21. Estebe JP, Morel M, Daouphars T, Ardant E, Rousseau C, Drouet A, Bosquet C, Boudjema K. Lessons from the analysis of a retrospective cohort of patients who underwent large open abdominal surgery under total intravenous opioid-free anesthesia. Drugs-Real World Outcomes. 2021 Mar;8:85-93. 22. Mulier H, De Frene B, Benmeridja L, Vanhoorebeeck F, Denis B, Casaer B, Rogge FJ, Leleu K, Mulier J. Impact of opioid-free anesthesia on complications after deep inferior epigastric perforator flap surgery: A retrospective cohort study. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2021 Mar 1;74(3):504-11. 23. Chin KJ, Dinsmore MJ, Lewis S, Chan V. Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients. European Spine Journal. 2020 Dec;29:138-44. 24. Shah SB, Chawla R, Pahade A, Mittal A, Bhargava AK, Kumar R. Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy. Indian Journal of Anaesthesia. 2020 Dec;64(12):1038. 25. Smith SA, Ghabra H, Dhaifallah DG, Rahnema A, Evans BM, Nossaman BD, Sumrall WD, Bardot SF, Canter DJ. Novel Opiate-Free Anesthetic Technique for Major Urologic Procedures. Southern Medical Journal. 2020 Oct 1;113(10):499-504. 26. Kruthiventi SC, Hofer RE, Warner ME, Sprung J, Kellogg TA, Weingarten TN. Postoperative nausea and vomiting after bariatric surgery and dexmedetomidine anesthetic: a propensity-weighted analysis. Surgery for Obesity and Related Diseases. 2020 Apr 1;16(4):545-53. 27. Ibrahem Amin OA, Kamel AA. Effects of adding ketamine to dexmedetomidine on smooth recovery from isoflurane anesthesia in adults undergoing endoscopic sinus surgery. Egyptian Journal of Anaesthesia. 2020 Jan 1;36(1):50-5 28. Bhardwaj S, Garg K, Devgan S. Comparison of opioid-based and opioid-free TIVA for laparoscopic urological procedures in obese patients. Journal of Anaesthesiology, Clinical Pharmacology. 2019 Oct;35(4):481. 29. Audenet F, Attalla K, Giordano M, Pfail J, Lubin MA, Waingankar N, Gainsburg D, Badani KK, Sim A, Sfakianos JP. Prospective implementation of a nonopioid protocol for patients undergoing robot-assisted radical cystectomy with extracorporeal urinary diversion. InUrologic Oncology: Seminars and Original Investigations 2019 May 1 (Vol. 37, No. 5, pp. 300-e17). Elsevier.
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spelling	Mendoza Obirne, MarioGarcia Cespedes, JavierCalle Alvarez, Elsy SofiaCampos Carrillo, Maria Paula2025-02-14T15:55:20Z2025-02-14T15:55:20Z2025-01https://hdl.handle.net/20.500.12495/13961instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coResumen Introducción: La combinación de dexmedetomidina y ketamina, conocida como "ketodex," ha surgido como una alternativa prometedora en anestesia general y sedación. Este enfoque potencia los efectos analgésicos y anestésicos de ambos fármacos, reduciendo sus efectos adversos individuales. Metodología: Se trató de una revisión sistemática de estudios sobre el uso de ketodex en anestesia general Resultados: Se identificaron 17 estudios relevantes, que incluyeron diversas cirugías. Estos estudios compararon anestesia tradicional versus anestesia libre de opioides, destacando la variabilidad en las dosis y técnicas de administración. El uso combinado de dexmedetomidina y ketamina en anestesia general se asocia con una reducción del dolor, menor necesidad de opioides, y una disminución de náuseas y vómitos postoperatorios. La evidencia limitada y la variabilidad subrayan la necesidad de más investigación sobre los beneficios y riesgos del ketodex en adultos. Conclusión: El uso combinado de dexmedetomidina y ketamina en anestesia general se asocia con una reducción del dolor, menor necesidad de opioides, y una disminución de náuseas y vómitos postoperatorios. Sin embargo, se requieren más estudios para respaldar firmemente su uso.Especialista en AnestesiologíaEspecializaciónAbstract Introduction: The combination of dexmedetomidine and ketamine, known as "ketodex," has emerged as a promising alternative for general anesthesia and sedation. This approach enhances the analgesic and anesthetic effects of both drugs, reducing their individual adverse effects. Methodology: This was a systematic review of studies on the use of ketodex in general anesthesia Results: Seventeen relevant studies were identified, which included a variety of surgeries. These studies compared traditional anesthesia versus opioid-free anesthesia, highlighting variability in dosage and administration techniques. The combined use of dexmedetomidine and ketamine in general anesthesia is associated with reduced pain, reduced need for opioids, and decreased postoperative nausea and vomiting. The limited evidence and variability highlight the need for further research about the benefits and risks of ketodex in adults. Conclusion: The combined use of dexmedetomidine and ketamine in general anesthesia is associated with reduced pain, reduced need for opioids, and decreased postoperative nausea and vomiting. However, further studies are required to firmly support its use.application/pdfAttribution-NonCommercial-ShareAlike 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertohttps://purl.org/coar/access_right/c_abf2http://purl.org/coar/access_right/c_abf2KetaminaDexmedetomidinaAnestesia generalDolor postoperatorioNauseas y vomito postoperatorioEscalofrio postoperatorioDelirium postoperatorioKetamineDexmedetomidineGeneral anesthesiaPostoperative painPostoperative nausea and vomitingPostoperative shiveringPostoperative deliriumWO 200Beneficios de la Ketamina y Dexmedetomidina en anestesia general: una revisión sistemáticaBenefits of Ketamine and Dexmedetomidine in general anesthesia: A systematic reviewEspecialización en AnestesiologíaUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aa1. López-Millán, J. M1, Sánchez-Blanco, C2.Current use of ketamine for the treatment of acute and chronic pain. Rev. Soc. Esp. Dolor vol.14 no.1 Madrid ene. 20072. Gillian M. Keating1 Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs (2015) 75:1119–11303. Ykeizumi LC, Correia da Silva R, Villar e Silva G. Combined Dexmedetomidine and Ketamine in Pediatric Anesthesia: A Brief Review. Anesth Pain Res. 2021; 5 (1): 1-8. Correspondence: Lilian Satie Ykeizumi MD. Anesthesiology Clinic, Marcílio Dias Naval Hospital, Brazilian Navy, Rio de Janeiro, Brazil. Received. 2021 Jan;10.4. Liaquat Z, Xu X, Zilundu PL, Fu R, Zhou L. The current role of dexmedetomidine as neuroprotective agent: an updated review. Brain sciences. 2021 Jun 25;11(7):846.5. Hou M, Chen F, He Y, Tan Z, Han X, Shi Y, Xu Y, Leng Y. Dexmedetomidine against intestinal ischemia/reperfusion injury: a systematic review and meta-analysis of preclinical studies. European Journal of Pharmacology. 2023 Sep 29:176090.6. kahashi K, Yoshikawa Y, Kanda M, Hirata N, Yamakage M. Dexmedetomidine as a cardioprotective drug: a narrative review. Journal of Anesthesia. 2023 Dec;37(6):961-70.7. Rayyan - AI Powered Tool for Systematic Literature Reviews [Internet]. 2021 [citado 12 de marzo de 2023]. Disponible en: https://www.rayyan.ai/8. Elsaeidy AS, Ahmad AH, Kohaf NA, Aboutaleb A, Kumar D, Elsaeidy KS, Mohamed OS, Kaye AD, Shehata IM. Efficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis. Current Pain and Headache Reports. 2024 Apr;28(4):211-279. Gao JW, Lin MY, Zou QF, Huang JL, Cheng MX. Effect of small-dose ketamine combined with dexmedetomidine on emergence stress response as well as postoperative pain and Th cell deviation in patients with cervical cancer surgery under general anesthesian. Journal of Hainan Medical University. 2017;23(8):75-9.10. Strickley T, Smith K, Ericksen AM. Dexmedetomidine–An Alternative to Midazolam in the Treatment of Ketamine-Induced Emergence Delirium: A Systematic Review. Journal of PeriAnesthesia Nursing. 2024 Apr 1;39(2):311-811. Duarte-Medrano G. Dexmedetomidina, tendencias y actuales aplicaciones. Revista Chilena de Anestesia. 2022;51(3):265-72.12. Sahraei R, Ghaedi M, Haghbeen M, Jahromi MS. Comparison Of Ketamine And Dexmedetomidine In Reducing Complications After Laparoscopic Cholecystectomy Surgery. International Journal of Medical Investigation. 2023 Jul 10;12(2):154-64.13. Ziemann-Gimmel P, Goldfarb AA, Koppman J, Marema RT. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. British journal of anaesthesia. 2014 May 1;112(5):906-11.14. Zhang Z, Zhang WH, Lu YX, Lu BX, Wang YB, Cui LY, Cheng H, Yuan ZY, Zhang J, Gao DP, Gong JF. Intraoperative Low-Dose S-Ketamine Reduces Depressive Symptoms in Patients with Crohn’s Disease Undergoing Bowel Resection: A Randomized Controlled Trial. Journal of Clinical Medicine. 2023 Feb 1;12(3):115215. Lodhi M, Sulakshana S, Singh AP, Gupta BK. A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia. Indian Journal of Anaesthesia. 2023 Feb;67(Suppl 2):S126.16. Zorrilla-Vaca A, Ramirez PT, Iniesta-Donate M, Lasala JD, Wang XS, Williams LA, Meyer L, Mena GE. Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2022 Dec;69(12):1477-92.17. Berlier J, Carabalona JF, Tête H, Bouffard Y, Le-Goff MC, Cerro V, Abrard S, Subtil F, Rimmelé T. Effects of opioid-free anesthesia on postoperative morphine consumption after bariatric surgery. Journal of Clinical Anesthesia. 2022 Oct 1;81:110906.18. Menck JT, Tenório SB, de Oliveira RM, Strobel R, dos Santos BB, Junior AF, de Cesaro MP. Opioid-free Anesthesia for Laparoscopic Gastroplasty. A Prospective and Randomized Trial. The Open Anesthesia Journal. 2022 Sep 30;16(1).19. Dey S, Kohli JK, Magoon R, ItiShri I, Kashav RC. Feasibility of opioid-free anesthesia for cervical rib excision: A case series and review of literature. Journal of Cardiac Critical Care TSS. 2021 Dec;5(03):208-13.20. Urvoy B, Aveline C, Belot N, Catier C, Beloeil H. Opioid-free anaesthesia for anterior total hip replacement under general anaesthesia: the Observational Prospective Study of Opiate-free Anesthesia for Anterior Total Hip Replacement trial. British Journal of Anaesthesia. 2021 Apr 1;126(4):e136-921. Estebe JP, Morel M, Daouphars T, Ardant E, Rousseau C, Drouet A, Bosquet C, Boudjema K. Lessons from the analysis of a retrospective cohort of patients who underwent large open abdominal surgery under total intravenous opioid-free anesthesia. Drugs-Real World Outcomes. 2021 Mar;8:85-93.22. Mulier H, De Frene B, Benmeridja L, Vanhoorebeeck F, Denis B, Casaer B, Rogge FJ, Leleu K, Mulier J. Impact of opioid-free anesthesia on complications after deep inferior epigastric perforator flap surgery: A retrospective cohort study. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2021 Mar 1;74(3):504-11.23. Chin KJ, Dinsmore MJ, Lewis S, Chan V. Opioid-sparing multimodal analgesia with bilateral bi-level erector spinae plane blocks in scoliosis surgery: a case report of two patients. European Spine Journal. 2020 Dec;29:138-44.24. Shah SB, Chawla R, Pahade A, Mittal A, Bhargava AK, Kumar R. Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy. Indian Journal of Anaesthesia. 2020 Dec;64(12):1038.25. Smith SA, Ghabra H, Dhaifallah DG, Rahnema A, Evans BM, Nossaman BD, Sumrall WD, Bardot SF, Canter DJ. Novel Opiate-Free Anesthetic Technique for Major Urologic Procedures. Southern Medical Journal. 2020 Oct 1;113(10):499-504.26. Kruthiventi SC, Hofer RE, Warner ME, Sprung J, Kellogg TA, Weingarten TN. Postoperative nausea and vomiting after bariatric surgery and dexmedetomidine anesthetic: a propensity-weighted analysis. Surgery for Obesity and Related Diseases. 2020 Apr 1;16(4):545-53.27. Ibrahem Amin OA, Kamel AA. Effects of adding ketamine to dexmedetomidine on smooth recovery from isoflurane anesthesia in adults undergoing endoscopic sinus surgery. Egyptian Journal of Anaesthesia. 2020 Jan 1;36(1):50-528. Bhardwaj S, Garg K, Devgan S. Comparison of opioid-based and opioid-free TIVA for laparoscopic urological procedures in obese patients. Journal of Anaesthesiology, Clinical Pharmacology. 2019 Oct;35(4):481.29. Audenet F, Attalla K, Giordano M, Pfail J, Lubin MA, Waingankar N, Gainsburg D, Badani KK, Sim A, Sfakianos JP. Prospective implementation of a nonopioid protocol for patients undergoing robot-assisted radical cystectomy with extracorporeal urinary diversion. InUrologic Oncology: Seminars and Original Investigations 2019 May 1 (Vol. 37, No. 5, pp. 300-e17). 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