• Obesity surgery · Jan 2008

    Review

    Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.

    • Roop Kaw, Loutfi Aboussouan, Dennis Auckley, Charles Bae, David Gugliotti, Paul Grant, Wael Jaber, Philip Schauer, and Daniel Sessler.
    • Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA. Kawr@ccf.org
    • Obes Surg. 2008 Jan 1;18(1):134-8.

    AbstractBariatric 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.

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