Obesity Surgery

, Volume 18, Issue 1, pp 134–138

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

  • Roop Kaw
  • Loutfi Aboussouan
  • Dennis Auckley
  • Charles Bae
  • David Gugliotti
  • Paul Grant
  • Wael Jaber
  • Philip Schauer
  • Daniel Sessler


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.


Perioperative management Pulmonary complications Obstructive sleep apnea Pulmonary hypertension Bariatric surgery 


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Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Roop Kaw
    • 1
  • Loutfi Aboussouan
    • 2
  • Dennis Auckley
    • 3
  • Charles Bae
    • 4
  • David Gugliotti
    • 1
  • Paul Grant
    • 5
  • Wael Jaber
    • 6
  • Philip Schauer
    • 7
  • Daniel Sessler
    • 8
  1. 1.Department of Hospital MedicineCleveland Clinic FoundationClevelandUSA
  2. 2.Department of Pulmonary and Critical Care MedicineCleveland ClinicClevelandUSA
  3. 3.Sleep CenterMetroHealth Medical CenterClevelandUSA
  4. 4.Department of Neurology and Sleep DisordersCleveland ClinicClevelandUSA
  5. 5.Department of General Internal MedicineUniversity of MichiganAnn ArborUSA
  6. 6.Department of CardiologyCleveland ClinicClevelandUSA
  7. 7.Bariatric and Metabolic InstituteCleveland ClinicClevelandUSA
  8. 8.Department of Outcomes ResearchCleveland ClinicClevelandUSA

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