Abstract
Introduction: In patients with obesity and mineral and vitamin deficiencies, the distribution of anesthetics occurs in the peripheral fat compartment, which is enlarged, delaying recovery from anesthesia. Based on this information, the choice of substances with faster recovery, lower production of active metabolites, and predictable elimination is recommended for anesthesia in bariatric surgery. Objective: This systematic review aimed to analyze the effects of dexmedetomidine and remifentanil on hemodynamics and renal function in patients undergoing bariatric surgery with vitamin and mineral deficiencies. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from September to October 2025 in the Scopus, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: 136 articles were found. A total of 52 articles were evaluated, and 31 were included in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 18 studies with high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=87.9% >50%. It was concluded that in obese patients with mineral and vitamin deficiencies, total intravenous anesthesia with opioid restriction using dexmedetomidine reduces postoperative nausea, pain score, and the need for antiemetics and analgesics in the immediate postoperative period after bariatric surgery compared to the use of remifentanil. Furthermore, the better recovery profile after laparoscopic sleeve gastrectomy supports the use of intraoperative dexmedetomidine infusion as an anesthetic adjuvant versus remifentanil for this patient profile.