الفهرس 
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Abstract
Obesity is a worldwide health problem and is an important respiratory risk factor. The implications of obesity on pulmonary physiology are well known. Morbidly obese patients are at risk of hypoxemia during the perioperative period, because of pre-existing alterations in lung and chest wall mechanics. Laparoscopic surgery offers major benefits to obese patient such as minimized incision size and trauma with reduced postoperative discomfort, shortened recovery rates and a lower incidence of postoperative wound infections. However, it is associated with more important intraoperative respiratory and circulatory changes than open surgery. The goal in anesthetic management of obese patients is to have proper anesthesia when needed, but a rapid emergence and resumption of adequate respiration and physiology immediately after the end of the procedure. Anything done to minimize the need of postoperative opioids and minimize the risk of postoperative nausea and vomiting is very valuable. Therefore, this patient population could benefit from a drug that can produce analgesic effects without significant or long-lasting effects on respiratory function. Dexmedetomidine is a selective α2-adrenergic receptor agonist. Several aspects of its pharmacology promise benefits not only for sedation in the ICU, but also for the perioperative period. The aim of this study was to compare the effects of two doses of dexmedetomidine infusion on oxygenation, lung mechanics, quality of recovery and perioperative analgesia in morbidly obese patients with restrictive lung disease undergoing laparoscopic abdominal surgery. This study was carried out at general surgery department, Tanta University Hospitals, on ninty morbidly obese patients scheduled for elective laparoscopic surgeries. Patients were allocated randomly into three groups (30 patients each): dexmedetomidine 0.3 group (group Dex 0.3), dexmedetomidine 0.6 group (group Dex 0.6), and control group (group C). In both groups Dex 0.3 and Dex 0.6, dexmedetomidine was given IV as a bolus dose of 1 μg/kg 15 minutes after endotracheal intubation followed by continuous infusion of 0.3 μg/kg/hr and 0.6 μg/kg/hr for one hour; respectively. In control group (C), a comparable volume of normal saline (0.9%) was given IV 15 min after endotracheal intubation. The main findings of this study were that intraoperative dexmedetomidine infusions improved oxygenation by decreasing dead space and increasing both static and dynamic compliance when compared with baseline values and when compared with control group as well. Furthermore, the postoperative quality of recovery was improved, the postoperative pain score was decreased, the time for the first request of analgesia was prolonged, as well as morphine consumption was reduced without increasing the risks of opioid-related side effects, such as postoperative respiratory depression or nausea and vomiting. It has also been shown that the effects of both doses of dexmedetomidine were nearly similar without any significant difference.