55 y.o. male 5'10" BMI 42 w/ h/o: chronic cervical radiculopathy (has intact nerve stim), obesity, HTN, DM, OSA.

presents for lap. roux en y, liver bx, ventral hernia repair.

me: induction included 35 mg ketamine bolus, Iso 0.8 MAC throughout, 8 mg morphine (first five put in 1st liter IVF and run over first 35-40 min of case - 3 towards the end), 400 mg fentanyl (150 on induction).

our surgeon likes us to use precedex for roux en y's. along with precedex gtt intro-op (5.5 hr case), what would you think an ideal amount of opioids is in this uncomplicated case?

i had a discussion with the on-call attending last night after the case (while waiting for extubation) about using opioids and precedex together, and addng volatiles on top of that, and determining what's adequate, and i want to see if what i did was far off from what others would do.