Ketodex Versus Opioid Based Anesthesia in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

Inclusion Criteria:

* Adult patients (\>18 years) undergoing Elective Bariatric Surgery .

  * American Society of Anesthesiologists physical status class II or III .
  * body mass index (BMI) \> 35 kg/m2 .

Exclusion Criteria:

* • Refusal to participate .

  * Any sensitivity or contraindication to ketamine or dexmedotomidine .
  * Pregnancy or breast feeding .
  * Patients with significant renal impairment .
  * Any patient on regular intake of beta blockers or calcium channel blockers .
  * CNS disorders eg: seizures , raised intra cranial tension .
  * Chronic opioid use.
  * Obese patients with STOP bang score more than 5 .