Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery.
OBJECTIVE
To develop evidence-based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients.


METHODS
This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book chapters). The search yielded 195 abstracts, of which 35 references were reviewed in detail. Task Group consensus was used to provide recommendations when evidence in the literature was insufficient.


RESULTS
We developed anesthesia practice and patient safety advisory recommendations for preoperative evaluation, intraoperative management, and postoperative care and pain management of WLS patients. We also provided suggestions related to medical error reduction and systems improvements, credentialing, and future research.


CONCLUSIONS
Obesity-related comorbidities including obstructive sleep apnea place WLS patients at increased risk for complications perioperatively. Regarding perioperative safety and outcomes, conclusive evidence beyond the accepted standard of care in the reviewed literature is limited. Few reports specifically address the perioperative needs of severely obese patients. In this advisory, we synthesize current knowledge and make best practice recommendations for perioperative care and pain management in WLS patients. These recommendations require periodic review as further medical knowledge and evidence evolve.
Schumann
Roman
R
Department of Anesthesia, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA. Rschumann@tufts-nemc.org
Jones
Stephanie B
SB
Ortiz
Vilma E
VE
Connor
Kathleen
K
Pulai
Istvan
I
Ozawa
Edwin T
ET
Harvey
Alan M
AM
Carr
Daniel B
DB
D000698:Analgesia / Q000379:methods*; D000758:Anesthesia / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D019300:Medical Errors / Q000517:prevention & control; D009765:Obesity / Q000150:complications / Q000601:surgery; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012891:Sleep Apnea Syndromes; D012907:Smoking; D015431:Weight Loss