title: Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland.
abstract: BACKGROUND
  In the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program.
  
  
  METHODS
  The perioperative approach was established together with all relevant disciplines. Pertinent topics for the anesthesiologists were; successful airway management, indications for more invasive monitoring, and the planning of the postoperative period and deposition. This retrospective analysis was approved by the local ethics committee. Data are mean [SD].
  
  
  RESULTS
  182 bariatric surgical procedures were performed (147 gastric bypass procedures (GBP; 146 (99.3%) performed laparascopically). GBP patients were 43 [10] years old, 78% female, BMI 45 [7] kg/m(2), 73% ASA physical status of 2. 42 patients (28.6%) presented with obstructive sleep apnea syndrome. 117 GBP (79.6%) patients were intubated conventionally by direct laryngoscopy (one converted to fiber-optic intubation, one aspiration of gastric contents). 32 patients (21.8%) required an arterial line, 10 patients (6.8%) a central venous line. Induction lasted 25 [16] min, the procedure itself 138 [42] min. No blood products were required. Two patients (1.4%) presented with hypothermia (<35 °C) at the end of their case. The emergence period lasted 17 [9] min. Postoperatively, 32 patients (21.8%) were transferred to the ICU (one ventilated). The other patients spent 4.1 [0.7] h in the post anesthesia care unit. 15 patients (10.2%) required take backs for surgical revision (two laparotomies).
  
  
  CONCLUSIONS
  The physiology and anatomy of bariatric patients demand a tailored approach from both the anesthesiologist and the perioperative team. The interaction of a multi-disciplinary team is key to achieving good outcomes and a low rate of complications.
  
  
  BACKGROUND
  DRKS00005437 (date of registration 16(th) December 2013).
authors.affiliation: Department of Anesthesia and Intensive Care, Kantonsspital Frauenfeld, Pfaffenholzstrasse, 48501 Frauenfeld, Switzerland.
authors.forename: Bastian
authors.initials: B
authors.lastname: Lindauer
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Steurer
authors.affiliation: Department of Surgery, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Markus K
authors.initials: MK
authors.lastname: Müller
authors.affiliation: Department of Anesthesia and Intensive Care, Kantonsspital Frauenfeld, Pfaffenholzstrasse, 48501 Frauenfeld, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dullenkopf
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods; D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage*; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D010348:Patient Care Team / Q000458:organization & administration; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications; D013557:Switzerland
chemical_list: D000777:Anesthetics
keywords: Anesthesia; Bariatric surgery; Complications; Obesity