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Anesthesia GL

Anesthesia Guidelines for Bariatric Surgery

Rev 12/31/2015 Lang-Quilici

New Version V6



- 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.





- 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.





- 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.

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