JobsFan

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I don't have much experience with bariatric surgery ... (though quite familiar with surgery on obese people)

in your preoperative work up is it important that the patient make some progress toward weight loss ? is there a maximum recommended bmi/weight?

thanks - not much of this gets funded in public institutions (where Australian anaesthetists get trained)

any other tips / insights gratefully received
 

teeva

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May 21, 2015
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In my workup? No, and also not my job. Probably yes for surgeon's, and for insurance approval.

I haven't done any for a while. But pts typically came to pre-surgical testing clinic and had workup done by surgeon's office including labs, EKG, and echo and whatever consults. Usually used video laryngoscopy for intubation. DL would have been ok in majority of cases, but we (anesthesia and surgical residents and attendings) liked to gather around the video screen and see what the airway ended up looking like. Well known, extremely skilled, respected, and liked surgeon could do lap RNY procedure in under 90 mins and lap gastric sleeve under 45 mins with residents. Towards the end, surgeon asks you to stick down some special gastric tube and inject some specific volume of diluted methylene blue to test for leak, then suction stomach. Since the stomach is now tiny, the solution tends to come out the mouth when you inject whatever volume surgeon wants. So make sure ETT cuff is well inflated and line the pt's mouth/face with towels to soak up the solution. And try not to spill and stain yourself. Patients were extubated and went to their own dedicated bariatric unit after pacu. Postop they tend to be a little histrionic, but by night time or the next day were back to normal. IV dilaudid was sufficient for postop pain.
 
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jwk

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Towards the end, surgeon asks you to stick down some special gastric tube and inject some specific volume of diluted methylene blue to test for leak, then suction stomach. Since the stomach is now tiny, the solution tends to come out the mouth when you inject whatever volume surgeon wants. So make sure ETT cuff is well inflated and line the pt's mouth/face with towels to soak up the solution.
Stick a yankauer suction in the pharynx before you start injecting the dye down the gastric tube - if it comes back up, it gets suctioned before it ever gets out of the mouth. Patients don't like blue skin, although some alcohol wipes will clean it up pretty well.
 
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ericL

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Our place had developed a protocol largely based around minimizing narcotics and hopefully minimizing per operative pulmonary complications. Essentially it meant no long acting narcotic and generally using precedex at the end for wake up and weaned off in pacu.
 
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JobsFan

JobsFan

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thanks for the info - what bmi or weight are you typically seeing for these procedures?