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Abstract

The majority of bariatric procedures are now performed by laparoscopy. Although this surgical approach is considered minimally invasive, the anesthetic management of any obese patient, whether undergoing laparotomy or laparoscopy, is always complex. There are many special considerations regarding care of these patients that every anesthesiologist must be familiar with in order to ensure a successful outcome. Clear evidence-based guidelines for anesthetic management do not exist, despite the fact that obese patients routinely undergo all types of surgical and invasive diagnostic procedures. This chapter will discuss anesthesia for laparoscopic bariatric surgery as practiced at my institution.

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References

  1. Schumann R, Jones SN, Cooper B, et al. Update on best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery, 2004–2007. Obesity (Silver Spring). 2009;17:889–94.

    Article  Google Scholar 

  2. Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.

    Article  PubMed  Google Scholar 

  3. Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23:2050–7.

    Article  PubMed  Google Scholar 

  4. Collins JS, Lemmens HJM, Brodsky JB, et al. Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obes Surg. 2004;14:1171–5.

    Article  PubMed  Google Scholar 

  5. Mulier JP, Dillemans B, Van Cauwenberge S. Impact of the patient’s body position on the intraabdominal workspace during laparoscopic surgery. Surg Endosc. 2010;24:1398–402.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Arain SR, Barth CD, Shankar H, et al. Choice of volatile anesthetic for the morbidly obese patient: sevoflurane or desflurane. J Clin Anesth. 2005;17:413–9.

    Article  CAS  PubMed  Google Scholar 

  7. Holte K, Klarskov B, Christensen DS, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg. 2004;240:892–9.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Schuster R, Alami RS, Curet MJ, et al. Intra-operative fluid volume influences postoperative nausea and vomiting after laparoscopic gastric bypass surgery. Obes Surg. 2006;16:848–51.

    Article  PubMed  Google Scholar 

  9. Wool DB, Lemmens HJ, Brodsky JB, et al. Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients. Obes Surg. 2010;20:698–701.

    Article  PubMed  Google Scholar 

  10. Davis SS, Mikami DJ, Newlin M, et al. Heating and humidifying of carbon dioxide during pneumoperitoneum is not indicated: a prospective randomized trial. Surg Endosc. 2006;20:153–8.

    Article  CAS  PubMed  Google Scholar 

  11. Lemmens HJ, Brodsky JB, Bernstein DP. Estimating ideal body weight – a new formula. Obes Surg. 2005;15:1082–3.

    Article  PubMed  Google Scholar 

  12. Ingrande J, Brodsky JB, Lemmens HJ. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011;113:57–62.

    Article  CAS  PubMed  Google Scholar 

  13. Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105 Suppl 1:i16–23.

    Article  CAS  PubMed  Google Scholar 

  14. Lemmens HJ, Brodsky JB. The dose of succinylcholine in morbid obesity. Anesth Analg. 2006;102:438–42.

    Article  CAS  PubMed  Google Scholar 

  15. Brodsky JB, Lemmens HJ, Saidman LJ. Obesity, surgery, and inhalation anesthetics – is there a “drug of choice”? Obes Surg. 2006;16:734.

    Article  PubMed  Google Scholar 

  16. Schumann R. Anaesthesia for bariatric surgery. Best Pract Res Clin Anaesthesiol. 2011;25:83–93.

    Article  CAS  PubMed  Google Scholar 

  17. Kheterpal S, Martin L, Shanks AM, et al. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology. 2009;110:891–7.

    Article  PubMed  Google Scholar 

  18. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617–31.

    Article  CAS  PubMed  Google Scholar 

  19. Nightingale CE, Cousins J, Fox WT, et al. Comment on Fourth National Audit Project from the Society of Bariatric Anaesthetists. Br J Anaesth. 2011;107:272–3.

    Article  CAS  PubMed  Google Scholar 

  20. Jense HG, Dubin SA, Silverstein PI, et al. Effect of obesity on safe duration of apnea in anesthetized humans. Anesth Analg. 1991;72:89–93.

    CAS  PubMed  Google Scholar 

  21. Boyce JR, Ness T, Castroman P, et al. A preliminary study of the optimal anesthesia positioning for the morbidly obese patient. Obes Surg. 2003;13:4–9.

    Article  PubMed  Google Scholar 

  22. Brodsky JB, Lemmens HJ, Brock-Utne JG, et al. Morbid obesity and tracheal intubation. Anesth Analg. 2003;94:732–6.

    Article  Google Scholar 

  23. Keller C, Brimacombe J, Kleinsasser A, et al. The Laryngeal Mask Airway ProSeal(TM) as a temporary ventilatory device in grossly and morbidly obese patients before laryngoscope-guided tracheal intubation. Anesth Analg. 2002;94:737–40.

    Article  PubMed  Google Scholar 

  24. Marrel J, Blanc C, Frascarolo P, et al. Videolaryngoscopy improves intubation condition in morbidly obese patients. Eur J Anaesthesiol. 2007;24:1045–9.

    Article  CAS  PubMed  Google Scholar 

  25. Aldenkortt M, Lysakowski C, Elia N, et al. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis. Br J Anaesth. 2012;109:493–502.

    Article  CAS  PubMed  Google Scholar 

  26. Talab HF, Zabani IA, Abdelrahman HS, et al. Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery. Anesth Analg. 2009;109:1511–6.

    Article  PubMed  Google Scholar 

  27. Weingarten TN, Kendrick ML, Swain JM, et al. Effects of CPAP on gastric pouch pressure after bariatric surgery. Obes Surg. 2011;21:1900–5.

    Article  PubMed  Google Scholar 

  28. Wong DT, Adly E, Ip HY, et al. A comparison between the Boussignac™ continuous positive airway pressure mask and the venturi mask in terms of improvement in the PaO2/F(I)O2 ratio in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial. Can J Anaesth. 2011;58:532–9.

    Article  PubMed  Google Scholar 

  29. Tufanogullari B, White PF, Peixoto MP, et al. Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg. 2008;106:1741–8.

    Article  CAS  PubMed  Google Scholar 

  30. Iyer CP, Robertson BD, Lenkovsky F, et al. Gastric bypass and On-Q pump: effectiveness of Soaker Catheter system on recovery of bariatric surgery patients. Surg Obes Relat Dis. 2010;6:181–4.

    Article  PubMed  Google Scholar 

  31. Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg. 2013;23:1333–40.

    Article  PubMed  Google Scholar 

  32. Leykin Y, Pellis T, Del Mestro E, et al. Perioperative management of 195 consecutive bariatric patients. Eur J Anaesthesiol. 2008;25:168–70.

    Article  CAS  PubMed  Google Scholar 

  33. Elliot JA, Patel VM, Kirresh A, et al. Fast-track laparoscopic bariatric surgery: a systematic review. Updates Surg. 2013;65:85–94.

    Article  Google Scholar 

  34. Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? Curr Opin Anaesthesiol. 2009;22:405–11.

    Article  PubMed  Google Scholar 

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Correspondence to Jay B. Brodsky MD .

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Brodsky, J.B. (2015). Anesthesia in Bariatric Surgery. In: Lucchese, M., Scopinaro, N. (eds) Minimally Invasive Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-15356-8_11

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  • DOI: https://doi.org/10.1007/978-3-319-15356-8_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15355-1

  • Online ISBN: 978-3-319-15356-8

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