Anesthesia Guidelines for Bariatric Surgery

PRE-PROCEDURAL                    

- Patients have preop labwork per anesthesia protocol.

- Cardiac consultation and relevant diagnostic studies are based on clinical concerns and specific disease patterns.

- Patients are fasted from midnight.

- Patients are to arrive at the hospital early enough to permit nursing and anesthesia evaluations.

- Patients on beta blockers are to take their evening and morning doses.

- Other routine medications are taken as directed by their internist, the surgeon, or by anesthesia. Oral hypoglycemic medications are usually held. And insulin is reduced or held.

- Patients ar evaluated by anesthesia before arrival in the OR. Airway management difficulty is carefully evaluated, graded, and charted.

PROCEDURAL

- Antibiotic prophylaxis is by SCIP protocol for gastric/biliary surgery to be given within 1 hour before incision.

- Two large bore intra-venous lines or a central line is required in ALL stapled bariatric cases.

- In the OR, EKG, NIBP, and pulse oximetry are applied before anesthesia induction.

- Preoxygenation is performed.

- At the discretion of the anesthesiologist, augmented patient position for the morbidly obese is performed and a difficult airway cart and instrumentation are available.

- Specific anesthesia regimens are left to each anesthesiologist's discretion.

- Neuraxial pain management is not standard.

- Postoperative pain management is routinely a surgical responsibility.

- Ketorolac is commonly given early with dose adjusted for age and renal function.

- Esophageal gastric intubation and manipulation is by surgical direction.

- Pressor support is given to maintain CV stability as indicated by individual patient response.

- FiO2 is adjusted and PEEP used subject to evidence of intraoperative oxygen desaturation.

- At case conclusion, neuromuscular blockade is reversed, verified by neuromuscular stimulator. Antiemetics are administered by discretion of the anesthesiologist.

- Patients are extubated with evidence of successful relaxant reversal with adequate tidal volume.

POST-PROCEDURAL

- Respirations are frequently assisted early after extubation.

- At the discretion of the anesthesiologist, the patient is transferred to PACU.

- Head up position is encouraged immediately postoperatively if vital signs permit.

- In patients with sleep apnea or airway obstruction, CPAP or biPAP may be be employed at the anesthesiologist's discretion.

- Discharge from PACU is routinely by protocol.

- PACU management of patients is a shared responsibility of surgeons and anesthesiologists.

- Early ambulation and activity is enforced by surgical protocol.

- Patients are seen in followup on post op day 1 by an anesthesiologist and hereafter as indicated.

In house anesthesia coverage exists 24/365.