Roux-in-Y Gastrojejunal Bypass: Which Anesthetic Technique Has Best Results?

Ruzzon, Arthur; Nassif, Paulo Afonso Nunes; Prigol, Lais; Buzo, Lucas; Wendler, Guilherme; Wendler, Eduardo; Wendler, Ilana Barrichello Torres; Ruzzon, Igor; Goveia, Caio Henrique Marchette; Gonçalves, Lucas Augusto Prestes

doi:10.1590/0102-672020200002e1530

Cited by 3 publications

(3 citation statements)

References 14 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients with chronic pain or opioid use, those undergoing revision surgery with the possibility of conversion to open, there may be a role for epidural analgesia. [ 29 ] Akin to the evolution in laparoscopic colorectal pain management, intrathecal morphine may be useful in a small subset of bariatric surgical patients, especially when there are multiple or significant risk factors for poorly controlled acute pain or risk of conversion to open surgery. [ 30 ]…”

Section: Regional Anesthesiamentioning

confidence: 99%

Perioperative Pain Management in Bariatric Anesthesia

Eipe

Budiansky

2022

Saudi J Anaesth

View full text Add to dashboard Cite

Weight loss (bariatric) surgery is the most commonly performed elective surgical procedure in patients with morbid obesity. In this review, we provide an evidence-based update on perioperative pain management in bariatric anesthesia. We mention some newer preoperative aspects—medical optimization, physical preparation, patient education, and psychosocial factors—that can all improve pain management. In the intraoperative period, with bariatric surgery being almost universally performed laparoscopically, we emphasize the use of non-opioid adjuvant infusions (ketamine, lidocaine, and dexmedetomidine) and suggest some novel regional anesthesia techniques to reduce pain, opioid requirements, and side effects. We discuss some postoperative strategies that additionally focus on patient safety and identify patients at risk of persistent pain and opioid use after bariatric surgery. This review suggests that the use of a structured, step-wise, severity-based, opioid-sparing multimodal analgesic protocol within an enhanced recovery after surgery (ERAS) framework can improve postoperative pain management. Overall, by incorporating all these aspects throughout the perioperative journey ensures improved patient safety and outcomes from pain management in bariatric anesthesia.

show abstract

Section: Regional Anesthesiamentioning

confidence: 99%

Perioperative Pain Management in Bariatric Anesthesia

Eipe

Budiansky

2022

Saudi J Anaesth

View full text Add to dashboard Cite

show abstract

“…The surgical and anesthesiological practice is under constant development, which means that the recommendations in the literature need to be questioned and updated 25,29 . There are reasons to believe that successful implementation of ERAS programs will lead to reduced hospital costs.…”

Section: /6mentioning

confidence: 99%

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

Wendler

Nassif

Malafaia

et al. 2021

ABCD, arq. bras. cir. dig.

Self Cite

View full text Add to dashboard Cite

Rational: The metabolic response to surgical trauma is enhanced by prolonged preoperative fasting, contributing to increased insulin resistance. This manifestation is more intense on the 1st and 2nd postoperative days and is directly proportional to the size of the operation. Aim: To compare whether preoperative fasting abbreviation and early postoperative refeeding associated with intraoperative and postoperative fluid restriction interfere in the evolution of patients undergoing gastrojejunal bypass. Methods: Eighty patients indicated for Roux-en-Y gastrojejunal bypass were selected. They were randomly divided into two groups: Ringer Lactate (RL) group, who underwent a 6 hours solids fasting, with the administration of 50 g of maltodextrin in 100 ml of mineral water 2 hours before the beginning of anesthesia; and Physiologic Solution (PS) group, who underwent a 12 hours solids and liquids fasting. Anesthesia was standardized for both groups. During the surgical procedure, 1500 ml of ringer lactate solution was administered in the RL and 2500 ml of physiological solution (0.9% sodium chloride) in the PS. In both groups, the occurrence of bronchoaspiration was analyzed during intubation, and the residual gastric volume was measured after opening the abdominal cavity. In the postoperative period in Group RL, patients started a liquid diet 24 hours after the end of the operative procedure; whilst for PS group, fasting was maintained for the first 24 hours, it was prescripted 2000 ml of physiological solution and a restricted liquid diet after 36 hours. Each patient underwent CPK, insulin, sodium, potassium, urea, creatinine, PaCO2, pH and bicarbonate dosage in the immediate postoperative period, and 48 hours later, the exams were repeated. Results: There were no episodes of bronchoaspiration and gastrojejunal fistulas in either group. In the analysis of the residual gastric volume of the PS and RL groups, the mean volumes were respectively 16.5 and 8.8, which shows statistical significance between the groups. In laboratory tests, there was no difference between groups in sodium; PS group showed a higher level of serum potassium (p=0.029); whilst RL group showed a higher urea and creatinine values; CPK values were even for both; PS group demonstrated a higher insulin level; pH was higher in PS group; sodium bicarbonate showed a significant difference at all times; PaCO2 values in RL group was higher than in PS. In the analysis of the incidence of nausea and flatus, no statistical significance was observed between the groups. Conclusions: The abbreviation of preoperative fasting and early postoperative refeeding of Roux-en-Y gastrojejunal bypass with the application of ERAS or ACERTO Project accelerated the patient’s recovery, reducing residual gastric volume and insulin level, and do not predispose to complications.

show abstract

“…T he increase in the obese population in the world is exponential, it is estimated that 30% of people are overweight or obese, significantly increasing morbidity and mortality from cardiovascular, oncological, endocrine and liver diseases, among others 11,38,41 .…”

Section: Introductionmentioning

confidence: 99%

Is the Waist/Height Ratio a Better Parameter Than Bmi in Determining the Cardiometabolic Risk Profile of Obese People?

MALAFAIA

Nassif

Lucas³

et al. 2021

ABCD, arq. bras. cir. dig.

Self Cite

View full text Add to dashboard Cite

Background: The increased prevalence of obesity has led to a significant increase in the occurrence of metabolic syndrome, a recognized risk factor for increased morbidity and mortality from cardiovascular diseases. Hyperglycemia or type 2 diabetes mellitus, dyslipidemia and arterial hypertension are its main components. Since 2015, international guidelines have recognized the benefits of bariatric surgery in each isolated factor of this syndrome. Aim: To evaluate the impact of Roux-en-Y gastric bypass in this syndrome comparing pre- and postoperative periods with laboratory analysis and to compare waist/height ratio and BMI in relation to the determination of the cardiometabolic risk profile. Methods: A retrospective study was carried out, selecting 80 patients undergoing Roux-en-Y gastric bypass. Total cholesterol, HDL, LDL, triglycerides, fasting glucose, glycated hemoglobin, insulin, body mass index (BMI), vitamin D, vitamin B12, waist circumference and waist/height ratio in three periods were analyzed: the preoperative period from 1 to 6 months, postoperative from 1 to 6 months and postoperative from 1 to 2 years. Results: There was an improvement in all parameters of the clinical analyses. The preoperative BMI had a mean value of 39.8, in the preoperative period from 1 to 6 months, the values dropped to 33.2 and in the postoperative period of 1 year, the mean was 26. The perimeter mean values of 118.5 preoperatively, 105.2 postoperatively from 1 to 6 months and 90.3 postoperatively from 1 to 2 years. Waist/height ratio was 0.73, 0.65 and 0.56 in pre, post 1 to 6 months and 1 to 2 years respectively. Conclusion: Roux-en-Y gastric bypass improves metabolic syndrome and waist-to-height ratio is superior to BMI in the assessment of the cardiometabolic risk profile.

show abstract

Roux-in-Y Gastrojejunal Bypass: Which Anesthetic Technique Has Best Results?

Cited by 3 publications

References 14 publications

Perioperative Pain Management in Bariatric Anesthesia

Perioperative Pain Management in Bariatric Anesthesia

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

Is the Waist/Height Ratio a Better Parameter Than Bmi in Determining the Cardiometabolic Risk Profile of Obese People?

Contact Info

Product

Resources

About