Enhanced Recovery After Bariatric Surgery
Mahmoud Hussein Abd Elmonem Sheleby;
Abstract
Obesity is a complex and multifactorial disease. Genetic, ethnic and socioeconomic factors may be contributed. Medical disorders such as Cushing's disease or hypothyroidism may predispose to obesity. Corticosteroids, antidepressants and certain other drugs may lead to weight gain.
Almost all organ systems are negatively affected by obesity. From an anesthesia and intensive care view the influence of obesity on the cardiovascular and the pulmonary systems are of particular relevance. OSA is strongly associated with obesity. Because OSA is undiagnosed in an estimated 60-70% of patients, screening for OSA should be part of routine preoperative evaluation.
Obesity is primarily managed in primary care with non surgical interventions such as lifestyle and behavioral interventions. However, as these fail and weight continues to increase, management may include pharmacological intervention and/or surgery. Bariatric surgeries compared with lifestyle interventions, result in a greater decrease in cardiovascular risk factors, and achieve higher remission of type 2 diabetes.
Great care should be taken in the Preoperative assessment. Careful history, clinical examination and investigations should be played more towards cardiovascular diseases, pulmonary functions as well as endocrinal abnormalities including thyroid function and diabetes mellitus.
Anesthetic management of obese patients should take into consideration the specific problems associated with obesity and optimize them before surgery. Antibiotics, anxiolysis, analgesia, and prophylaxis against both aspiration pneumonitis and DVT should be addressed during premedication.
Intraoperative considerations include proper positioning of extremely obese patients. Particular care should be paid to protection of pressure areas, because pressure sores and neural injuries are more common in this group, especially, super obese and diabetic. Proper monitoring of these high risk patients with full routine monitors, specially, capnometry and pulse oximetry should be done.
General anesthesia is better as regard ventilation which should be controlled. However, a combined method of epidural (good for postoperative pain relief) and general anesthesia is the best procedure in the anesthetic management in extremely obese patients.
The most important complications that may face the obese patients postoperatively include respiratory problems, D.V.T, and pulmonary embolism (PE), wound infections and complications of bariatric surgery.
Oxygen supplementation is essential postoperatively. Adequate pain relief and measures to avoid deep venous thrombosis and pulmonary embolism, including early ambulation is important.
Almost all organ systems are negatively affected by obesity. From an anesthesia and intensive care view the influence of obesity on the cardiovascular and the pulmonary systems are of particular relevance. OSA is strongly associated with obesity. Because OSA is undiagnosed in an estimated 60-70% of patients, screening for OSA should be part of routine preoperative evaluation.
Obesity is primarily managed in primary care with non surgical interventions such as lifestyle and behavioral interventions. However, as these fail and weight continues to increase, management may include pharmacological intervention and/or surgery. Bariatric surgeries compared with lifestyle interventions, result in a greater decrease in cardiovascular risk factors, and achieve higher remission of type 2 diabetes.
Great care should be taken in the Preoperative assessment. Careful history, clinical examination and investigations should be played more towards cardiovascular diseases, pulmonary functions as well as endocrinal abnormalities including thyroid function and diabetes mellitus.
Anesthetic management of obese patients should take into consideration the specific problems associated with obesity and optimize them before surgery. Antibiotics, anxiolysis, analgesia, and prophylaxis against both aspiration pneumonitis and DVT should be addressed during premedication.
Intraoperative considerations include proper positioning of extremely obese patients. Particular care should be paid to protection of pressure areas, because pressure sores and neural injuries are more common in this group, especially, super obese and diabetic. Proper monitoring of these high risk patients with full routine monitors, specially, capnometry and pulse oximetry should be done.
General anesthesia is better as regard ventilation which should be controlled. However, a combined method of epidural (good for postoperative pain relief) and general anesthesia is the best procedure in the anesthetic management in extremely obese patients.
The most important complications that may face the obese patients postoperatively include respiratory problems, D.V.T, and pulmonary embolism (PE), wound infections and complications of bariatric surgery.
Oxygen supplementation is essential postoperatively. Adequate pain relief and measures to avoid deep venous thrombosis and pulmonary embolism, including early ambulation is important.
Other data
| Title | Enhanced Recovery After Bariatric Surgery | Other Titles | تعزيز الإفاقة بعد جراحــات علاج السمنة المفرطة | Authors | Mahmoud Hussein Abd Elmonem Sheleby | Issue Date | 2016 |
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