Anesthetic Considerations for Bariatric Surgery

Ogunnaike, Babatunde; Jones, Stephanie B.; Jones, Daniel B.; Provost, David A.; Whitten, Charles W.

doi:10.1097/00000539-200212000-00061

Cited by 246 publications

(152 citation statements)

References 118 publications

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“…24 By the same token, body water was diminished (less than the usual 50% to 55%), not because there were signs of dehydration, but as a consequence of exaggerated adiposity, with a reduced relative contribution of water-rich lean body mass to actual weight. 4,5,25 Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV 1 ) were basically well conserved in the study group, despite serious changes in body composition and consequently in thoraco-abdominal anatomy. Indeed, surgical candidates are usually screened for heavy smoking, chronic bronchitis, asthma, pulmonary hypertension, and other serious respiratory conditions that might increase anesthetic risk.…”

Section: Discussionmentioning

confidence: 97%

“…5 Both daytime and especially nocturnal neurophysiology may be impaired in association with obstructive sleep apnea. The tendency toward gastroesophageal reflux because of high intra-abdominal pressure along with hypoventilation may trigger various derangements; chronic bronchitis 6 and asthma 7,8 are not unusual; and after surgical operations, atelectasis is relatively common.…”

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confidence: 99%

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Pulmonary function and aerobic capacity in asymptomatic bariatric candidates with very severe morbid obesity

et al. 2004

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PURPOSE:Aerobic capacity and respiratory function may be compromised in obesity, but few studies have been done in highly obese bariatric candidates. In a prospective study, these variables were documented in the preoperative period, aiming to define possible physiologic limitations in a apparently healthy and asymptomatic population.METHOD: Forty-six consecutively enrolled adults (age 39.6 ± 8.4 years, 87.0% females, body mass index /BMI 49.6 ± 6.3 kg/m 2 ) were analyzed. Ventilatory variables were investigated by automated spirometry, aerobic capacity was estimated by a modified Bruce test in an ergometric treadmill, and body composition was determined by bioimpedance analysis.RESULTS: Total fat was greatly increased (46.4 ± 4.6% of body weight) and body water reduced (47.3 ± 4.6 % body weight), as expected for such obese group. Spirometric findings including forced vital capacity of 3.3 ± 0.8 L and forced expiratory volume-1 second of 2.6 ± 0.6 L were usually acceptable for age and gender, but mild restrictive pulmonary insufficiency was diagnosed in 20.9%. Aerobic capacity was more markedly diminished, as reflected by very modest maximal time (4.5 ± 1.1 min) and distance (322 ±142 m) along with proportionally elevated maximal oxygen consumption (23.4 ± 9.5 mL/kg/min) achieved by these subjects during test exercise.CONCLUSIONS: 1) Cardiopulmonary evaluation was feasible and well-tolerated in this severely obese population; 2) Mean spirometric variables were not diminished in this study, but part of the population displayed mild restrictive changes; 3) Exercise tolerance was very negatively influenced by obesity, resulting in reduced endurance and excessive metabolic cost for the treadmill run; 4) More attention to fitness and aerobic capacity is recommended for seriously obese bariatric candidates;

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Pulmonary function and aerobic capacity in asymptomatic bariatric candidates with very severe morbid obesity

et al. 2004

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“…Present fluid management paradigms are based on studies of liberal versus restrictive strategies in non-obese patients whereby fluid excess or 'imbalance' resulted in worsened outcomes than maintaining 'fluid balance' [88,89]. In morbidly obese patients, data from non-randomised studies [90][91][92][93] support 'liberal' fluid regimens which were associated with reduced occurrence of RML (up to 4-5 L crystalloid during a 2-3 h operation [90]), reduced postoperative nausea and vomiting (25 ml/kg which in this study equated to a mean ±SD 3209 ± 1123 versus 2737 ± 828 ml administered intraoperatively) [92], postoperative ARF (4-5L crystalloid for a 2 h operation [93]) and shortened hospital stay (7 ml/ kg/h which in this study equated to[1750 ml administered intraoperatively) [94]. In more conservative intraoperative fluid regimens (15 ml/kg), there were no differences in postoperative RML following laparoscopic bariatric surgery compared to more liberal strategies (40 ml/kg) [95].…”

Section: Perioperative Fluid Managementmentioning

confidence: 99%

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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Background During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based ''enhanced'' perioperative protocol. Methods The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. Results Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. Conclusions A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.

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“…33 The circumstances that would make these patients appropriate candidates for free-standing facilities continue to be a matter of debate. The College of Physicians and Surgeons of British Columbia has published guidelines based on body mass index (BMI, weight in kg/height in metres squared) 34 that include a recommendation that patients with a BMI [ 35 requiring a general anesthetic should not be considered suitable candidates for non-hospital surgical facilities except under extraordinary circumstances.…”

Section: Bariatric Surgerymentioning

confidence: 99%

Office-based anesthesia

Kurrek

Twersky

2010

Can J Anesth/J Can Anesth

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Purpose Ambulatory office-based anesthesia (OBA) is a relatively new but rapidly growing field. OBA requires a different approach than that used in the hospital, because there are unique considerations that must be recognized when administering anesthesia in a free-standing office facility. This review provides a summary of the important issues and aspects of safe patient care. Methods The Medline, Embase, Biological Abstract, Science Citation Index, and Healthstar databases were searched under

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Anesthetic Considerations for Bariatric Surgery

Cited by 246 publications

References 118 publications

Pulmonary function and aerobic capacity in asymptomatic bariatric candidates with very severe morbid obesity

Pulmonary function and aerobic capacity in asymptomatic bariatric candidates with very severe morbid obesity

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Office-based anesthesia

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