Anaesthesia for bariatric surgery
作者： Roman Schumann
DOI: 10.1016/J.BPA.2010.12.006
关键词: Anesthesia 、 Gastric bypass 、 Wound infiltration 、 Perioperative 、 Medicine 、 Surgery 、 Airway management 、 Local anaesthetic 、 Trendelenburg position 、 Postoperative pain 、 Surgical patients
摘要: Although many smaller studies have addressed anaesthetic care for bariatric surgical patients, comprehensive systematic literature reviews yet to be compiled, and much evidence includes expert panel opinion. This review summarises study results in patients regarding pre-anaesthesia evaluation, the perioperative impact of sleep-disordered breathing, airway management at induction emergence, maintenance anaesthesia, postoperative pain management, utility clinical-care pathways feasibility outpatient surgery. The ‘ramped’ upper-body, reversed Trendelenburg position manual application positive end-expiratory pressure (PEEP) is recommended. Intra-operative hypoxaemia can treated with combination PEEP recruitment manoeuvres, attention emergence critical. Local wound infiltration non-steroidal anti-inflammatory drugs should part multimodal opioid-sparing analgesia. Implementation seems beneficial. Considering prevalence sleep apnoea these surgery remains controversial, but probably safe certain procedures, provided there strict adherence preoperative eligibility home-care protocols.
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