58 - Anesthesia for Bariatric Surgery

Abstract

Obesity is a growing epidemic in the United States and worldwide. Current estimates are that more than 2 out of 3 adults in the US are overweight or obese. Body mass index (BMI) is used to quantify an individual’s tissue mass (weight divided by square root of height – kg/m2) where BMI > 30 is considered obese. Surgery for obesity is one of the fastest growing surgeries performed worldwide. Patients presenting for bariatric surgery frequently have other medical comorbidities such as insulin resistance, type 2 diabetes mellitus, obstructive sleep apnea (OSA), cardiovascular disease, hypertension, asthma, chronic obstructive pulmonary syndrome, and obesity hypoventilation syndrome. Preoperative evaluation should focus on these cardiopulmonary and metabolic issues as well as the patient’s airway. Patient preparation and positioning are keys to successful airway management. Intraoperatively, appropriate drug dosing based on drug lipid solubility as well as maximizing pulmonary mechanics by using positive end expiratory pressure and recruitment maneuvers are critical. Postoperatively, these patients should be closely monitored for obstruction, hypoventilation or over-sedation. Morbidly obese patients may need to be placed on the CPAP machines with continuous monitoring of their capnography and pulse oximetry to minimize the risk of obstruction in the PACU. A multi-modal approach to pain management is recommended to minimize the risk of hypoventilation and apnea postoperatively. Obese patients presenting for nonbariatric surgery benefit from anesthetic approaches similar to that used for bariatric surgery.