Gastric Banding and the Surgicenter

[turnupthevapor]

Our surgeons want to start performing some gastric banding at one of our surgicenters.

Only problem is it is at a place with only 1 anesthesiologist. There will be no one around to help with the induction. What is your experience with these patients in an outpatient facilty? One bad outcome I would imagine could sink the facility!

I was thinking we should have a glidescope there, cpap for RR, etc. My major concern is only one anesthesiologist there...4 hands are definatley better than 2.


whats your thoughts?

Thank you
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[toughlife]

Our surgeons want to start performing some gastric banding at one of our surgicenters.

Only problem is it is at a place with only 1 anesthesiologist. There will be no one around to help with the induction. What is your experience with these patients in an outpatient facilty? One bad outcome I would imagine could sink the facility!

I was thinking we should have a glidescope there, cpap for RR, etc. My major concern is only one anesthesiologist there...4 hands are definatley better than 2.


whats your thoughts?

Thank you
​

A difficult airway cart is definitely indicated. Glidescope and noninvasive ventilation equipment also key to make your life easier.

 

[pgy13]

Our surgeons want to start performing some gastric banding at one of our surgicenters.

Only problem is it is at a place with only 1 anesthesiologist. There will be no one around to help with the induction. What is your experience with these patients in an outpatient facilty? One bad outcome I would imagine could sink the facility!

I was thinking we should have a glidescope there, cpap for RR, etc. My major concern is only one anesthesiologist there...4 hands are definatley better than 2.


whats your thoughts?


Set some limits, if you can. e.g. max BMI, severity of sleep apnea, etc. There are several reports in the literature of doing bands safely at surgicenters, but I personally think you're playing with fire, partcularly in the postop period. If you only have one anesthesiologist and a big patient with sleep apnea gets in trouble in the PACU, anesthesiologist is back in the OR, now what?​

 

[cchoukal]

a difficult airway cart, glidescope, and cpap machine all sounds really expensive. is there a financial incentive for the anesthesia group to add these cases to the center? will you ever recoups these capital expenses by doing these cases?

 

[zonker1]

I would think that by avoiding even one anoxic event due to cannot intubate/cannot ventilate the costs will be more then recovered.

 

[drmwvr]

I would think that by avoiding even one anoxic event due to cannot intubate/cannot ventilate the costs will be more then recovered.

It seems to me that the issues in the or would be the same for any unexpected difficult airway. Obese pts have outpatient surgery for things other than lap banding and, unless the truely massive (500-600# or so?) are candidates, my experience is that their airways are no more difficult than what you would expect to find generally. Anticipated diff airways would be treated as such as with any procedure. Clearly, some comorbidities would disqualify for an ASC. I agree, the issue lies primarily in recovery. That would be the deal breaker.

 

[Bertelman]

whats your thoughts?​

Don't center-justify your text. It's more difficult to read.

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[ssmallz]

I don't see how these cases can be done w/out those tools. We have a surgeon in our program who must do 8-12/week. Whenever we're in that room a glidescope or some other difficult airway kit is a must. Its saved our butt a bunch of times. FWIW his patients always stay overnight in the hospital and sometimes you'll find a coupla unexpected post op complications.

 

[Pilot Doc]

I would think that by avoiding even one anoxic event due to cannot intubate/cannot ventilate the costs will be more then recovered.

Sure, but the other option is to avoid the capital expenditure by not performing those cases at the surgicenter.

 

[turnupthevapor]

Good thoughts everyone!

Bertelman is this better?
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