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BMC Anesthesiology

, 14:125

Perioperative medicine and outcome


BackgroundIn the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program.

MethodsThe perioperative approach was established together with all relevant disciplines. Pertinent topics for the anesthesiologists were; successful airway management, indications for more invasive monitoring, and the planning of the postoperative period and deposition. This retrospective analysis was approved by the local ethics committee. Data are mean SD.

Results182 bariatric surgical procedures were performed 147 gastric bypass procedures GBP; 146 99.3% performed laparascopically. GBP patients were 43 10 years old, 78% female, BMI 45 7 kg-m, 73% ASA physical status of 2. 42 patients 28.6% presented with obstructive sleep apnea syndrome. 117 GBP 79.6% patients were intubated conventionally by direct laryngoscopy one converted to fiber-optic intubation, one aspiration of gastric contents. 32 patients 21.8% required an arterial line, 10 patients 6.8% a central venous line. Induction lasted 25 16 min, the procedure itself 138 42 min. No blood products were required. Two patients 1.4% presented with hypothermia <35°C at the end of their case. The emergence period lasted 17 9 min. Postoperatively, 32 patients 21.8% were transferred to the ICU one ventilated. The other patients spent 4.1 0.7 h in the post anesthesia care unit. 15 patients 10.2% required take backs for surgical revision two laparotomies.

ConclusionsThe physiology and anatomy of bariatric patients demand a tailored approach from both the anesthesiologist and the perioperative team. The interaction of a multi-disciplinary team is key to achieving good outcomes and a low rate of complications.

Trial registrationDRKS00005437 date of registration 16 December 2013

KeywordsAnesthesia Complications Bariatric surgery Obesity  Download fulltext PDF

Autor: Bastian Lindauer - Marc P Steurer - Markus K Müller - Alexander Dullenkopf


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