Perioperative Care in the MGB and Anesthetic Management

  • Jan Apers
  • Martin Dunkelgrun
  • Marcel de Quelerij
  • Serge Verbrugge
  • Ulas Biter
Chapter

Abstract

Following the example of colorectal surgery, bariatric surgery experienced a similar development in perioperative practice: Enhanced Recovery After Bariatric Surgery (ERABS) is a clinical pathway or multimodal perioperative program, developed to improve clinical outcome of surgery. This program includes pre-, intra-, and post-operative alterations, such as standardized pre-operative information and counseling, preoperative fasting, smoking cessation, pre-habilitation, laparoscopy, more specifically experienced surgeons and anesthetists, short working narcotics, perioperative stress reduction, reduction of pain and opioid medication and the use of a standardized protocol or checklist for early discharge. This program must be monitored routinely, analyzing the results achieved in the past.

Studies show that ERABS is safe and feasible, and results in a reduction in length of stay (LOS) without an increase in complications. However, these studies did not show any significant reduction in complications. The benefits from ERABS are improvements and reduction of costs. That is why it is not surprising that ERABS is often mixed up with fast-track bariatric surgery: all the aspects of ERABS make early discharge, on the first post-operative day, safe and feasible.

The most important anesthetic goals in ERABS are: quick induction and emergence of anesthesia, facilitating quick surgery and low complication rate like PONV (Post-operative Nausea and Vomiting). The goals are quick ambulation (prevention of thrombosis/emboli) and preventing respiratory complications by using multimodal analgesia with as little opioids as possible. One study has been published on ERABS after MGB, demonstrating safety.

Keywords

Enhanced recovery ERAS ERABS Fast-track bariatric surgery Clinical pathway Mini-gastric bypass One-anastomosis gastric bypass Anesthesiology 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jan Apers
    • 1
  • Martin Dunkelgrun
    • 1
  • Marcel de Quelerij
    • 2
  • Serge Verbrugge
    • 2
  • Ulas Biter
    • 1
  1. 1.Department of Bariatric and Metabolic SurgeryFranciscus GasthuisRotterdamThe Netherlands
  2. 2.Department of AnesthesiologyFranciscus GasthuisRotterdamThe Netherlands

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