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It is time for

Opioid Free Anaesthesia in 2016!

 “Synthetic opioids were introduced in the anaesthetic paradigm many years ago.This was because they provided remarkable hemodynamic stability in comparison with other anaesthetics available in the early seventies.
Moreover, they were qualified as particularly "safe" when considering only immediate postoperative recovery.
Accordingly, synthetic opioids became the corner stone of modern "balanced" anaesthesia.

Today, however, it is time to question their use in light of the following points:

Synthetic opioids given during anaesthesia induce a phenomenon called opioid induced hyperalgesia. This is borne out by significantly increased pain during the recovery period and sometimes after (chronic post surgical pain).

Synthetic opioids interfere with patients immune defense. This is suspected to be harmful for patients undergoing oncologic surgery.

Synthetic opioids increase the rate of nausea and vomiting.

In summary, the use of this class of drugs seems not to be in accordance with the new goals of perioperative medicine like enhanced recovery after surgery.
Additionally at the present time numerous safe alternatives exist to replace synthetic opioids in our daily practice.”

Prof. Marc DeKock, University of Leuven, Belgium
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Editor’s Notes-The 6th ESPCOP meeting
Becoming addicted to Opioid Free Anaesthesia

“I prefer to talk about opiates and opioids rather than give these drugs to my patients” said  Prof Marc De Kock -  The Grandfather of OFA as Mike Margarson introduced him at Annual SOBA Meeting in London before his  talk about Synthetic Opioids
Prof DeKock opened also the 6th ESPCOP meeting with a master lecture about   “The time for OFA in 2016  “
We were very lucky this year to be able to comprehensively explore the topic of OFA at  6th ESPCOP  annual meeting in Bruges, a few days before Christmas. The two day event brought together many brilliant European speakers to look at the issues surrounding OFA: explaining how to give the anaesthesia , what additives and how to use them and  a  survey highlighting the experiences and insights of anaesthetists practicing OFA all over the world.  All these clearly demonstrated the benefits of using “our “ endogenous morphine and invigorated us to follow this strategy particularly with morbidly obese patients.
Professors Jan Mulier and Luc de Baerdemaeker  gave a live demonstration of OFA the day before the scientific meeting at AZ Sint-Jan  Hospital. This was very well received as the attendees had an opportunity to see the theory in action,and after the anaesthesia they could see what we all want: A happy patient!
OFA is clearly the issue of the year as it was covered at the SOBA meeting in London and the ISPCOP meetings too.This trend will definitely continue and more of us will be persuaded and become OFA addicts.

                                               Daniela Godoroja, ESPCOP Secretary
See 6th ESPCOP meetings in Pictures
Download the lectures

What next for ESPCOP ?

The ESPCOP session at Euroanaesthesia London
 Key differences in respiratory and airway management of the obese patient – Monday 30th May 2016

The 16th World Congress of Anaesthesiologists- ESPCOP will  join  ISPCOP , SOBA and SASM in a full day of an Obesity Tract  on Thursday 1st September 2016 in Hong Kong. The details will follow soon...
See the programme

The 7th ESPCOP meeting will be in Gent on  December 16-17 with topic- Monitoring in Anaesthesia for the Morbidly Obese
The meeting will be preceded by a Hands on- Airway Workshop with  focus on the morbidly obese where all airways techniques will be demonstrated by experts, including invasive  techniques on porcine airway models and airway ultrasound
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Reports of recent meetings

ISPCOP's 4th Annual Symposium Report

Frontiers in Anesthesia and Obesity - October 26, 2015, San Diego

Rainer Lenhardt on the topic of protective mechanical ventilation

The 4th  Annual ISPCOP Symposium was held on Monday October 26  at the W Hotel, during the ASA annual meeting 2015. Meeting attendance surpassed that of the prior symposia, and participants witnessed an exciting program again this year developed by the organizing committee of Drs. Anu Wadhwa, Stephanie Jones and Roman Schumann, under the leadership of Dr. Rainer Lenhardt. Opening remarks by Dr. Jones were followed by an introduction of the meeting host Dr. Lenhardt who guided the audience through a diverse program. Bukky Nafiu (US) presented on the link between childhood obesity and asthma in the perioperative setting. Adrian Sultana (Australia) provided his experience and study results while discussing the controversial use of the laryngeal mask airway in morbidly obese patients.

Dr. Lenhardt moderated the scientific poster discussions as part of the program that was followed by short oral presentations of the winners of the 3 top scientific abstracts. This year’s best abstract and winner of the 2015 ISPCOP Research Award was presented by Dr. Etienne Couture of Laval University, Québec, entitled “EPO2 : PV Evaluation of Pre-Oxygenation in Morbidly Obese: Effect of Position and Ventilation”.

 For the closing keynote lecture, Paolo Pelosi (Italy) was unexpectedly unable to attend the meeting, but he provided his material that was very ably presented by Rainer Lenhardt on the topic of protective mechanical ventilation and outcomes in morbidly obese patients. CME credits were again available to participants. We are looking forward to the 5th Annual ISPCOP Symposium in Chicago in 2016 and hope to see you there.

Roman Schumann, ISPCOP President

Obesity Week was held from October 2 to 6 in Los Angeles, California. Obesity Week features an annual interdisciplinary conference organized by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS). The goal of Obesity Week is to bring the latest education on science and treatment of obesity including bariatric surgery.
 An integral part of bariatric surgery and non-bariatric surgery on the morbidly obese patient is our field of anaesthesiology. Thus, the International Society for the Perioperative Care of the Obese Patient (ISPCOP) teamed up with ASMBS to provide a symposium about key issues in adult and pediatric bariatric anesthesia. The symposium was  held on November 4, 2015 under the chairmanship of Dr. Stephanie Jones, the immediate past president of ISPCOP.

Read more
What next for ISPCOP ?

IARS 2016 Annual Meeting and International Science Symposium, Improving Health Through Discovery and Education  will be held at San Francisco this year from Saturday, May 21 – Tuesday, May 24 and ISPCOP has an important participation in a Panel Bariatric Anesthesia – Use of Evidence and Technology to Optimise Care  and Problem-Based Learning Discussions
How Big is Too Big for Outpatient Surgery?
Tonsillectomy in Obese Children:
Fools Dare Where Angels Fear to Tread!


5th Annual ISPCOP Symposium
Tipping the Scales in 2016: A New Look at Regional Anaesthesia, Neuromuscular Blockade and Opioids in the Patient with Obesity
ASA 2016, Chicago, IL Monday, October 24, 2016 ,
6:30 – 9:00 pm, venue TBA

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We had a very successful scientific meeting in London December 2015 and have the following plans for 2016.

  • 'Key Issues in Anaesthesia for the Morbidly Obese’ -May 27th Royal College of Physicians in London.This course runs the day before  Euroanaesthesia  2016 begins in London and will be a bigger version to allow for many delegates from Europe looking for expert training in obesity anaesthesia.
  • WCA in Hong Kong we are working with ESPCOP, SASM,ISPCOP to deliver and support the Obesity Tract day
  • November 11th in York at the wonderful and historic venue ‘The Hospitium’. 'Key Issues in Anaesthesia for the Morbidly Obese’
  • The SOBA-UK Annual Scientific Meeting with AGM- on December 2nd  at Royal College of Physicians in London. 
All details will be on website in February to allow on-line booking.
  • There will be a call for all those who are considered ‘Obesity Leads’ within their departments to register/join a more specialist email group forum to support dissemination of central information and opportunities. The sign up for this will be on in February.
  • Bariatric Anaesthetic Fellowships are growing in number in the UK and we know hold a complete register of these and seek any departments from across the globe to register their fellowships with us so we can inform the many enquiries that SOBA gets monthly how to locate and contact such amazing fellowships.
  • SOBA Membership is now available on line at

Expect 2 more Single Sheet Guidelines for widespread use to be released this year.

                                                           John Cousins, SOBA Chairman

Newsletter Editor feedback and suggestion are very welcome!

Newsletter Editor : Daniela Godoroja 
Newsletter Editor SOBA-UK: Abigail Hine
Newsletter Editor ISPCOP: David Torres
Newsletter Language Editor: Mike Margarson