Obstructive sleep apnea can be safely managed in a level 2 critical care setting after laparoscopic bariatric surgery

Shearer, E.S.; Magee, Conor; Lacasia, C.; Raw, David; Kerrigan, David

doi:10.1016/j.soard.2012.09.006

Cited by 26 publications

(9 citation statements)

References 17 publications

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“…Hence, routine preoperative clinical screening for OSA with confirmatory polysomnography may be considered, with further diagnostic testing and treatment of appropriate at‐risk patients . However, the data are generally mixed in terms of overall benefit of screening, with several studies showing no risk reduction with OSA screening or treatment .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

321

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

321

464

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“…No observational evidence directly addressing the question was found. Meta-analysis of observational studies suggested that patients with obstructive sleep apnea or related disorders were more likely to sustain atrial fibrillation (OR 1.51, 95% CI 1.36 to 1.69) or hypoxemia (WMD − 3.8%, 95% CI − 5.4% to − 2.2%) [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. The latter outcome might not be clinically important, whereas the summary certainty in the evidence was very low due to risk of bias (non-controlled confounders in cohort studies), imprecision, statistical and conceptual heterogeneity (differences in definition of sleep apnea and method of diagnosis) (Supplementary Table 6).…”

Section: Justificationmentioning

confidence: 99%

Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP

et al. 2020

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Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

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“…Two out of 192 patients were in need of CPAP due to low oxygen saturation. No patients were admitted to the ICU for additional respiratory support [15]. Although the present study is not sufficient to conclude the standard administration of a standard amount of oxygen to severe OSA patients for the first postoperative night, it could be considered.…”

Section: Discussionmentioning

confidence: 84%

“…Evidence justifying postoperative ICU admission is scarce. Several studies show that routine ICU admission is not required, and continuous monitoring by means of pulse oximetry or capnography alone may be sufficient [15,16]. The American Society of Anesthesiologists has put forth recommendations for the perioperative care of patients with OSA.…”

Section: Introductionmentioning

confidence: 99%