title: Perioperative management of bariatric surgery patients.
abstract: OBJECTIVE
  The perioperative management of bariatric surgery patients is described.
  
  
  CONCLUSIONS
  Obesity and anatomical changes create unique challenges for clinicians when caring for bariatric surgery patients. Common bariatric surgery procedures performed include Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Pain management in the acute postoperative period depends on careful dosing of opioid agents and the use of adjunctive agents. Prevention and management of infectious complications include appropriate surgical prophylaxis, monitoring and rapid treatment of suspected intra-abdominal infections, and detection and treatment of Helicobacter pylori infection. Venous thromboembolism (VTE) prophylaxis and treatment are complicated by obesity, and the use of pharmacologic agents must be balanced with bleeding risk. Bleeding is a serious complication that should be closely monitored in the immediate postoperative period. Blood products remain first-line therapy for the treatment of bleeding in this population. Acute differences in drug absorption as well as emerging hormonal changes necessitate the immediate postoperative adjustment of chronic medications to ensure both safety and efficacy. Pharmacists are valuable members of interprofessional teams for bariatric surgery patients because they provide expertise on the availability of dosage forms and dosage modification to ensure that patient pharmacotherapy is not interrupted; assist in the management of hypertension, diabetes, and psychotropic medications; and ensure appropriate antimicrobial prophylaxis and VTE prophylaxis and treatment dosages.
  
  
  CONCLUSIONS
  The management of patients in the perioperative period of bariatric surgery requires appropriate selection and dosing of medications for pain management and treatment of infectious complications, VTE, bleeding, and other chronic diseases.
authors.affiliation: April Miller Quidley, Pharm.D., BCPS, FCCM, is Postgraduate Year 2 Critical Care Residency Program Director and Critical Care Pharmacist II, Vidant Medical Center, Greenville, NC. Christopher M. Bland, Pharm.D., BCPS, is Pharmacist/Infectious Disease Pharmacist, Critical Care, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, and Adjunct Assistant Professor, South Carolina College of Pharmacy, University of South Carolina (USC), Columbia. P. Brandon Bookstaver, Pharm.D., BCPS (AQ-ID), AAHIVP, is Associate Professor and Vice Chair, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, USC. Kristi Kuper, Pharm.D., BCPS, GSPC, is Clinical Pharmacy Manager, VHA Performance Services, Charlotte, NC. aprilmillerrx@gmail.com.
authors.forename: April Miller
authors.initials: AM
authors.lastname: Quidley
authors.affiliation: April Miller Quidley, Pharm.D., BCPS, FCCM, is Postgraduate Year 2 Critical Care Residency Program Director and Critical Care Pharmacist II, Vidant Medical Center, Greenville, NC. Christopher M. Bland, Pharm.D., BCPS, is Pharmacist/Infectious Disease Pharmacist, Critical Care, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, and Adjunct Assistant Professor, South Carolina College of Pharmacy, University of South Carolina (USC), Columbia. P. Brandon Bookstaver, Pharm.D., BCPS (AQ-ID), AAHIVP, is Associate Professor and Vice Chair, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, USC. Kristi Kuper, Pharm.D., BCPS, GSPC, is Clinical Pharmacy Manager, VHA Performance Services, Charlotte, NC.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bland
authors.affiliation: April Miller Quidley, Pharm.D., BCPS, FCCM, is Postgraduate Year 2 Critical Care Residency Program Director and Critical Care Pharmacist II, Vidant Medical Center, Greenville, NC. Christopher M. Bland, Pharm.D., BCPS, is Pharmacist/Infectious Disease Pharmacist, Critical Care, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, and Adjunct Assistant Professor, South Carolina College of Pharmacy, University of South Carolina (USC), Columbia. P. Brandon Bookstaver, Pharm.D., BCPS (AQ-ID), AAHIVP, is Associate Professor and Vice Chair, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, USC. Kristi Kuper, Pharm.D., BCPS, GSPC, is Clinical Pharmacy Manager, VHA Performance Services, Charlotte, NC.
authors.forename: P Brandon
authors.initials: PB
authors.lastname: Bookstaver
authors.affiliation: April Miller Quidley, Pharm.D., BCPS, FCCM, is Postgraduate Year 2 Critical Care Residency Program Director and Critical Care Pharmacist II, Vidant Medical Center, Greenville, NC. Christopher M. Bland, Pharm.D., BCPS, is Pharmacist/Infectious Disease Pharmacist, Critical Care, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, and Adjunct Assistant Professor, South Carolina College of Pharmacy, University of South Carolina (USC), Columbia. P. Brandon Bookstaver, Pharm.D., BCPS (AQ-ID), AAHIVP, is Associate Professor and Vice Chair, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, USC. Kristi Kuper, Pharm.D., BCPS, GSPC, is Clinical Pharmacy Manager, VHA Performance Services, Charlotte, NC.
authors.forename: Kristi
authors.initials: K
authors.lastname: Kuper
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D006801:Humans; D009765:Obesity / Q000601:surgery; D009767:Obesity, Morbid / Q000601:surgery; D010149:Postoperative Pain / Q000188:drug therapy; D019990:Perioperative Care / Q000379:methods*; D010595:Pharmacists; D011183:Postoperative Complications / Q000188:drug therapy