<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1726-6718</journal-id>
<journal-title><![CDATA[Revista Cubana de Anestesiología y Reanimación]]></journal-title>
<abbrev-journal-title><![CDATA[Rev cuba anestesiol reanim]]></abbrev-journal-title>
<issn>1726-6718</issn>
<publisher>
<publisher-name><![CDATA[Editorial Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1726-67182022000200008</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Anestesia total intravenosa libre de opioides guiada por qCON y qNOX en paciente obesa]]></article-title>
<article-title xml:lang="en"><![CDATA[Opioid-free total intravenous anesthesia guided by qCON y qNOX in a female obese patient]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cevallos Sacoto]]></surname>
<given-names><![CDATA[Francisco Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Puga Bravo]]></surname>
<given-names><![CDATA[Cristina Evelyn]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Morocho Romero]]></surname>
<given-names><![CDATA[Emily Ariella]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Molineros Morales]]></surname>
<given-names><![CDATA[Luis Alfredo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Vicente Corral Moscoso  ]]></institution>
<addr-line><![CDATA[ Cuenca]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Ministerio de Salud Pública  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Ejercicio particular  ]]></institution>
<addr-line><![CDATA[ Cuenca]]></addr-line>
<country>Ecuador</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2022</year>
</pub-date>
<volume>21</volume>
<numero>2</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S1726-67182022000200008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S1726-67182022000200008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S1726-67182022000200008&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  En los últimos años la anestesia libre de opioides ha constituido una alternativa más a las técnicas tradicionales de anestesia general. Con la exclusión de este grupo de fármacos se evitan los múltiples efectos adversos y complicaciones asociados al mismo. A pesar de que la anestesia libre de opioides tiene sus indicaciones y que ha demostrado sus beneficios en cierto grupo de pacientes, existen aún controversias en relación con su utilidad en el paciente obeso. Características como la obesidad hacen que los modelos multimodales empleados para programar la anestesia libre de opioides sean cada vez más complejos.  Objetivos:  Describir un caso clínico realizado con la técnica de anestesia libre de opioides que constituye la primera experiencia en Ecuador.  Presentación del caso:  Se presenta el caso de una paciente obesa intervenida de colecistectomía laparoscópica mediante infusión de propofol, ketamina, lidocaína, sulfato de magnesio, y dexmedetomidina. La titulación de estos fármacos se realizó mediante cálculo de concentraciones plasmáticas a través de modelos farmacocinéticos y guiada por monitorización de profundidad anestésica y analgésica, con lo cual se logró optimizar el consumo de fármacos, disminuir las complicaciones y una evolución clínica favorable. Hasta donde se conoce a nivel local y de país (Ecuador) es la primera experiencia que se reporta con esta técnica.  Conclusiones: La anestesia libre de opioides puede resultar una elección en el paciente obeso ya que asegura una adecuada recuperación sin efectos adversos asociados.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  In recent years, opioid-free anesthesia has become another alternative in front of traditional general anesthesia techniques. The exclusion of this group of drugs avoids the numerous adverse effects and complications associated with its usage. Although opioid-free anesthesia has its indications and has showed its benefits in a certain group of patients, there is still controversy regarding its usefulness in the obese patient. Characteristics such as obesity make the multimodal models used to program opioid-free anesthesia increasingly complex.  Objectives:  To describe a clinical case involving the opioid-free anesthesia technique, which is the first experience in Ecuador.  Case presentation:  The case is presented of a female obese patient who underwent laparoscopic cholecystectomy by infusion of propofol, ketamine, lidocaine, magnesium sulfate and dexmedetomidine. Titration of these drugs was carried out by calculating plasma concentrations through pharmacokinetic models and guided by monitoring of anesthetic and analgesic depth, thus optimizing drug consumption, reducing complications and achieving a favorable clinical evolution. As far as known locally and in the country (Ecuador), this is the first reported experience with this technique.  Conclusions:  Opioid-free anesthesia may be a choice in the obese patient, since it ensures adequate recovery without associated adverse effects.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[anestesia total intravenosa]]></kwd>
<kwd lng="es"><![CDATA[anestesia libre de opioides]]></kwd>
<kwd lng="es"><![CDATA[hipnosis]]></kwd>
<kwd lng="es"><![CDATA[dolor]]></kwd>
<kwd lng="es"><![CDATA[concentración plasmática]]></kwd>
<kwd lng="es"><![CDATA[modelo farmacocinético.]]></kwd>
<kwd lng="en"><![CDATA[total intravenous anesthesia]]></kwd>
<kwd lng="en"><![CDATA[opioid-free anesthesia]]></kwd>
<kwd lng="en"><![CDATA[hypnosis]]></kwd>
<kwd lng="en"><![CDATA[pain]]></kwd>
<kwd lng="en"><![CDATA[plasma concentration]]></kwd>
<kwd lng="en"><![CDATA[pharmacokinetic model]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mulier]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anestesia libre de opioides: ¿un cambio de paradigma?]]></article-title>
<source><![CDATA[Revista Española de Anestesiología y Reanimación]]></source>
<year>2017</year>
<volume>64</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>427-30</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ghiringhelli]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Fuentes]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[O'Reilly]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anestesia libre de opioides en hemicolectomía abierta derecha extendida. Reporte de un caso y revisión]]></article-title>
<source><![CDATA[Revista Chilena de Anestesia]]></source>
<year>2020</year>
<volume>49</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>893-903</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ledowski]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Objective monitoring of nociception: a review of current commercial solutions]]></article-title>
<source><![CDATA[Br J Anaesth]]></source>
<year>2019</year>
<volume>123</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>e312-21</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Melia]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Gabarron]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Agustí]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Souto]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Pineda]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Fontanet]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery]]></article-title>
<source><![CDATA[J Clin Monit Comput]]></source>
<year>2017</year>
<volume>31</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1273-81</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Julien Marsollier]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Rachdi]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Caballero]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Ayanmanesh]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Vacher]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Horlin]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children]]></article-title>
<source><![CDATA[Br J Anaesth]]></source>
<year>2018</year>
<volume>121</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>462-8</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fabela Barragán]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Mille Loera]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Alvarado Pérez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[García Velasco]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Cuellar Guzmán]]></surname>
<given-names><![CDATA[LF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[De la anestesia convencional a la anestesia libre de opioides]]></article-title>
<source><![CDATA[Rev Mex Anest]]></source>
<year>2017</year>
<volume>40</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>126-8</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Muñoz Ramón]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Galván Guijo]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tolerancia aguda e hiperalgesia inducida por mórficos en una paciente polintervenida]]></article-title>
<source><![CDATA[Med Intensiva]]></source>
<year>2013</year>
<volume>37</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>366-7</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gil Martín]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Moreno García]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez Rubio]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Molina García]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hiperalgesia asociada al tratamiento con opioides]]></article-title>
<source><![CDATA[Revista de la Sociedad Española del Dolor]]></source>
<year>2014</year>
<volume>21</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>259-69</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Malo Manso]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Díaz Crespo]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Escalona Belmonte]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Romero Molina]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Cruz Mañas]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Guerrero Orriach]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Impacto de la anestesia libre de opioides en cirugía bariátrica]]></article-title>
<source><![CDATA[Anales del Sistema Sanitario de Navarra]]></source>
<year>2020</year>
<volume>43</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>51-6</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Escalona Belmonte]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Romero Molina]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Sepúlveda Haro]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Malo Manso]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Guerrero Orriach]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Narcolepsy and opioid-free anesthesia: a review and case report]]></article-title>
<source><![CDATA[Rev Esp Anestesiol Reanim (Engl Ed)]]></source>
<year>2021</year>
<volume>68</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>165-70</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Soto]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Naranjo González]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Calero]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intravenous lidocaine infusion]]></article-title>
<source><![CDATA[Rev Esp Anestesiol Reanim (Engl Ed)]]></source>
<year>2018</year>
<volume>65</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>269-74</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ramírez-Villagómez]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Ramírez-Villagómez]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Efecto de la técnica anestésica y el uso de opioides en la función inmune del paciente quirúrgico oncológico]]></article-title>
<source><![CDATA[Anestesia en México]]></source>
<year>2018</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>35-40</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bakan]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Umutoglu]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Topuz]]></surname>
<given-names><![CDATA[U]]></given-names>
</name>
<name>
<surname><![CDATA[Uysal]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Bayram]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Kadioglu]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study]]></article-title>
<source><![CDATA[Brazilian Journal of Anesthesiology (Eng Ed)]]></source>
<year>2015</year>
<volume>65</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>191-9</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pérez Atilano]]></surname>
<given-names><![CDATA[TA]]></given-names>
</name>
<name>
<surname><![CDATA[Olvera Romo]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Anestesia libre de opioides: revisión y reporte de un caso]]></article-title>
<source><![CDATA[Lux Médica]]></source>
<year>2016</year>
<volume>11</volume>
<numero>33</numero>
<issue>33</issue>
<page-range>29-36</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Abad Gurumeta]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Ripollés Melchor]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Casans Francés]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Calvo Vecino]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Monitorización de la nocicepción, ¿realidad o ficción?]]></article-title>
<source><![CDATA[Rev Esp Anestesiol Reanim]]></source>
<year>2017</year>
<volume>64</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>406-14</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jensen]]></surname>
<given-names><![CDATA[EW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[New findings and trends for depth of anesthesia monitoring]]></article-title>
<source><![CDATA[Korean J Anesthesiol]]></source>
<year>2018</year>
<volume>71</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>343-4</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
