Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
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.
Kaw
Roop
R
Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA. Kawr@ccf.org
Aboussouan
Loutfi
L
Auckley
Dennis
D
Bae
Charles
C
Gugliotti
David
D
Grant
Paul
P
Jaber
Wael
W
Schauer
Philip
P
Sessler
Daniel
D
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