domingo, 22 de febrero de 2015

Anestesia en cirugía bariátrica / Anesthesia for bariatric surgery

Diplomado en Terapia Respiratoria
 
24 Enero - 25 Julio 2015  

AVALES
Universidad Autónoma del Estado de México
Asociación Mexicana de Terapia Respiratoria
Medicina Respiratoria Hospital Ángeles Mocel México, DF

Mayores informes en: cuidadosneurocriticos.com
Manejo anestésico en pacientes de cirugía bariátrica. Experiencia de dos años en una institución en Suiza
Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland.
Lindauer B1, Steurer MP2, Müller MK3, Dullenkopf A1.
BMC Anesthesiol. 2014 Dec 18;14:125. doi: 10.1186/1471-2253-14-125. eCollection 2014.
Abstract
BACKGROUND: In the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program. METHODS: The perioperative approach was established together with all relevant disciplines. Pertinent topics for the anesthesiologists were; successful airway management, indications for more invasive monitoring, and the planning of the postoperative period and deposition. This retrospective analysis was approved by the local ethics committee. Data are mean [SD]. RESULTS: 182 bariatric surgical procedures were performed (147 gastric bypass procedures (GBP; 146 (99.3%) performed laparascopically). GBP patients were 43 [10] years old, 78% female, BMI 45 [7] kg/m(2), 73% ASA physical status of 2. 42 patients (28.6%) presented with obstructive sleep apnea syndrome. 117 GBP (79.6%) patients were intubated conventionally by direct laryngoscopy (one converted to fiber-optic intubation, one aspiration of gastric contents). 32 patients (21.8%) required an arterial line, 10 patients (6.8%) a central venous line. Induction lasted 25 [16] min, the procedure itself 138 [42] min. No blood products were required. Two patients (1.4%) presented with hypothermia (<35 °C) at the end of their case. The emergence period lasted 17 [9] min. Postoperatively, 32 patients (21.8%) were transferred to the ICU (one ventilated). The other patients spent 4.1 [0.7] h in the post anesthesia care unit. 15 patients (10.2%) required take backs for surgical revision (two laparotomies). CONCLUSIONS: The physiology and anatomy of bariatric patients demand a tailored approach from both the anesthesiologist and the perioperative team. The interaction of a multi-disciplinary team is key to achieving good outcomes and a low rate of complications.
KEYWORDS: Anesthesia; Bariatric surgery; Complications; Obesity
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