Perioperatives anästhesiologisches Management bei 167 Patienten mit bariatrischen Eingriffen

Abstract

In the long run, surgical treatment proves to the most effective measure for the treatment of both morbid adipositas and concomitant morbidity. Patients undergoing bariatric surgical procedures are a challenge to the anaesthesiologist: Obesity-associated morbidity, the potentially difficult airway and intravenous accesses as well as the demand for effective pain and anti-emetic therapy. Interrestingly, only sparse and conflicting data exist about the perioperative anaesthesiological management of these patients. This study retrospectively reviewed the previous perioperative anaesthesiological management and appraised critically the situation in the follow-ing analysis. A potential for improvement should be identified and included into a new SOP via the PDCA cycle of the quality management system. Retrospectively, peri-operative charts of all patients undergoing gastric banding or gastric bypass procedures within the last five years at our obesity treatment centre were analysed. Anesthesiological treatment be-fore, during and after the bariatric surgery as well as the pain therapy were documented. Adherence to the standard operating procedures, processing -times and qualification of the anaesthesiologist were further specific benchmarks. Overall, 167 patient charts were available for this survey (n = 103 gastric banding and n = 64 gastric bypass). Most of the patients (64 %) had anaesthesiologically relevant co-morbidites. Significant differences between the bypass and the banding groups were found for the median processing times. The need for postoperative opiods differs significantly as well (9 vs. 12 mg Piritramid). No severe anaesthesiological complications occurred. The overall rate of PONV was impressive with 32 %. Based on a pre-existing SOP, even a large number of different anaesthesiologists of various qualification levels was able to conduct anaethesia in a very homogeneous way. Bariatric patients are a high risk patient group. Present-day anaesthesiological practice as well as the profound implementation of a SOP could permit safe anaesthesia and a minimised risk for complications. Due to the high PONV rate, a routine perioperative PONV prophylaxis should be implemented.