title: Perioperative management of the morbidly obese adolescent with heart failure undergoing bariatric surgery.
abstract: The incidence and prevalence of adolescent obesity and adolescent heart failure are increasing, and anesthesiologists increasingly will encounter patients with both conditions. A greater understanding of the physiologic challenges of adolescent heart failure as they relate to the perioperative stressors of anesthesia and bariatric surgery is necessary to successfully manage the perioperative risks faced by this growing subpopulation. Here, we present a representative case of a morbidly obese adolescent with heart failure who underwent a laparoscopic bariatric operation and review the limited available literature on perioperative management in this age group. Specifically, we review evidence and offer recommendations related to preoperative evaluation, venous thromboembolism prophylaxis, positioning, induction, airway management, monitoring, anesthetic maintenance, ventilator management, and adverse effects of the pneumoperitoneum, rhabdomyolysis, and postoperative care.
authors.affiliation: Departments of Anesthesiology and Pediatric Cardiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA 94305-5640, USA. bmaxwell@stanford.edu
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Maxwell
authors.forename: Jerry
authors.initials: J
authors.lastname: Ingrande
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
authors.forename: Chandra
authors.initials: C
authors.lastname: Ramamoorthy
mesh_terms: D000293:Adolescent; D060666:Airway Extubation; D058109:Airway Management; D001017:Aortic Coarctation / Q000150:complications; D050110:Bariatric Surgery; D005260:Female; D006327:Heart Block / Q000150:complications; D016027:Heart Transplantation; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D010138:Pacemaker, Artificial; D019990:Perioperative Care; D011229:Preanesthetic Medication; D011300:Preoperative Care