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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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.
Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.
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.
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.
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.
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.
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.
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.
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.
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.
Lemmens HJ, Brodsky JB, Bernstein DP. Estimating ideal body weight – a new formula. Obes Surg. 2005;15:1082–3.
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.
Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105 Suppl 1:i16–23.
Lemmens HJ, Brodsky JB. The dose of succinylcholine in morbid obesity. Anesth Analg. 2006;102:438–42.
Brodsky JB, Lemmens HJ, Saidman LJ. Obesity, surgery, and inhalation anesthetics – is there a “drug of choice”? Obes Surg. 2006;16:734.
Schumann R. Anaesthesia for bariatric surgery. Best Pract Res Clin Anaesthesiol. 2011;25:83–93.
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.
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.
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.
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.
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.
Brodsky JB, Lemmens HJ, Brock-Utne JG, et al. Morbid obesity and tracheal intubation. Anesth Analg. 2003;94:732–6.
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.
Marrel J, Blanc C, Frascarolo P, et al. Videolaryngoscopy improves intubation condition in morbidly obese patients. Eur J Anaesthesiol. 2007;24:1045–9.
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.
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.
Weingarten TN, Kendrick ML, Swain JM, et al. Effects of CPAP on gastric pouch pressure after bariatric surgery. Obes Surg. 2011;21:1900–5.
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.
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.
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.
Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg. 2013;23:1333–40.
Leykin Y, Pellis T, Del Mestro E, et al. Perioperative management of 195 consecutive bariatric patients. Eur J Anaesthesiol. 2008;25:168–70.
Elliot JA, Patel VM, Kirresh A, et al. Fast-track laparoscopic bariatric surgery: a systematic review. Updates Surg. 2013;65:85–94.
Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? Curr Opin Anaesthesiol. 2009;22:405–11.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
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
Download citation
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
eBook Packages: MedicineMedicine (R0)