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Challenges in Pulmonary Risk Assessment and Perioperative Management in Bariatric Surgery Patients

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Abstract

Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.

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Authors and Affiliations

  1. Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue—S70, Cleveland, OH, 44195, USA

    Roop Kaw & David Gugliotti

  2. Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA

    Loutfi Aboussouan

  3. Sleep Center, MetroHealth Medical Center, Cleveland, OH, USA

    Dennis Auckley

  4. Department of Neurology and Sleep Disorders, Cleveland Clinic, Cleveland, OH, USA

    Charles Bae

  5. Department of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Paul Grant

  6. Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA

    Wael Jaber

  7. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA

    Philip Schauer

  8. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA

    Daniel Sessler

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  1. Roop Kaw
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  2. Loutfi Aboussouan
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Correspondence to Roop Kaw.

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Kaw, R., Aboussouan, L., Auckley, D. et al. Challenges in Pulmonary Risk Assessment and Perioperative Management in Bariatric Surgery Patients. OBES SURG 18, 134–138 (2008). https://doi.org/10.1007/s11695-007-9282-0

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  • DOI: https://doi.org/10.1007/s11695-007-9282-0

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