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Anesthesia for bariatric surgery raises unique and challenging
issues. Patients with morbid obesity often have coexisting
medical problems such as hypertension, diabetes and sleep apnea.
These can complicate their medical management.
These factors along with the
physical handling of morbidly obese individuals are taken into account
to ensure the delivery of a safe anesthetic.
The preoperative evaluation
allows the anesthesia team to not only assess the patient and formulate
an anesthetic plan so as to be prepared on the day of surgery, but also
allows the patient to ask questions and begin to understand what the
anesthetic process involves. When patients pre-admit, the nursing
staff will explain the basic process and procedure to be performed on
the day of surgery. The anesthetic will be discussed as well as
the implications of coexisting medical conditions and body mass index
of the patient.
In the holding area, the
anesthesia team reviews hospital data and medical records as well as
answers questions for the patient. Because most of our procedures
are done laparoscopically whether they are banding or bypass, a single
peripheral IV is all that is needed. If the patient does not have
an easily accessible peripheral vein, a central line may need to be
placed. This special IV involves placing a catheter under sterile
conditions either into the jugular vein of the neck or the subclavian
vein under the collarbone. This is the exception, not the
rule. Occasionally an arterial line will need to be placed in the
artery of the wrist, if blood pressures are technically difficult to
obtain from the arm. The skin will be numbed and the patient
sedated for either of these procedures.
If during the assessment the anesthesia team feels the patient has a
difficult airway, they will prepare the patient for an awake
intubation. A difficult airway can only be determined at the time of
surgery. It is the safest way to successfully intubate, or place
a breathing tube, in a patient with a small mouth, large neck or high
BMI. This will be discussed prior to the start of anesthesia on the day
of surgery. Again, it is the exception, not the norm. The
goal is to provide the safest anesthetic possible for the challenging
bariatric patient.
The anesthesiologist and
nurse anesthetist will monitor your vital signs and oxygenation and
level of anesthesia carefully during your procedure. You will be
given pain medicine and medicine for nausea if necessary. You
will be monitored closely in the recovery room. Many bariatric
patients have sleep apnea which may require a longer stay in the
recovery room before discharge.
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