title: Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
abstract: Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.
authors.affiliation: Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA. Kawr@ccf.org
authors.forename: Roop
authors.initials: R
authors.lastname: Kaw
authors.forename: Loutfi
authors.initials: L
authors.lastname: Aboussouan
authors.forename: Dennis
authors.initials: D
authors.lastname: Auckley
authors.forename: Charles
authors.initials: C
authors.lastname: Bae
authors.forename: David
authors.initials: D
authors.lastname: Gugliotti
authors.forename: Paul
authors.initials: P
authors.lastname: Grant
authors.forename: Wael
authors.initials: W
authors.lastname: Jaber
authors.forename: Philip
authors.initials: P
authors.lastname: Schauer
authors.forename: Daniel
authors.initials: D
authors.lastname: Sessler
mesh_terms: D050110:Bariatric Surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D019990:Perioperative Care; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology; D018570:Risk Assessment; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology