Difference between revisions of "Roux-en-Y gastric bypass"

From WikiAnesthesia
VisualWikitext
(Created blank page)
 
(started the page. Added patient evaluation. Edited pre-operative and intraoperative management.)
Line 1: Line 1:
{{Infobox surgical case reference
| anesthesia_type = General
| airway = ETT
| lines_access = PIV
OG tube
| monitors = Standard, nasal temp
| considerations_preoperative = Potential difficult airway and ventilation
| considerations_intraoperative = Rapid sequence, ramped position
| considerations_postoperative = PONV, IV tylenol
}}


Provide a brief summary of this surgical procedure and its indications here.
==Preoperative management==
===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
|-
|Cardiovascular
|Evaluate for hypertension
OSA causing pulmonary arterial hypertension
|-
|Respiratory
|Evaluate BMI for decreased FRC
Evaluate OSA status for difficult mask ventilation
|-
|Gastrointestinal
|Consider delayed gastric emptying with diabetes mellitus
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|Consider delayed gastric emptying with diabetes mellitus
|-
|Other
|
|}
===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->===
* sleep study (AHI score if available) for OSA
===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===
* Consider ramp for airway management
* Consider video laryngoscopy
* OG tube
===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===
* Minimize perioperative sedation
===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
==Intraoperative management==
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
* Standard ASA monitors
===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
* Consider rapid sequence induction
* Video laryngoscopy can be helpful for anticipated difficult airways
===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
* Supine
* Extreme reverse Trendelenburg (place baseboard by feet)
===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
* OG tube is advanced through the surgical anastamosis to prevent backwall suturing of anastamosis
** Surgical and anesthesia communication and coordination is important to guide OGT through anastamosis
===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===
==Postoperative management==
===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->===
* PACU
===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===
* Moderate pain: IV and oral narcotics
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===
* Bleeding
* Thromboemobolic events
* Aspiration
* Backwall suture of anastamosis
==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==
{| class="wikitable"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}
==References==
[[Category:Surgical procedures]]

Revision as of 11:39, 17 May 2021

Roux-en-Y gastric bypass
Anesthesia type

General

Airway

ETT

Lines and access

PIV OG tube

Monitors

Standard, nasal temp

Primary anesthetic considerations
Preoperative

Potential difficult airway and ventilation

Intraoperative

Rapid sequence, ramped position

Postoperative

PONV, IV tylenol

Article quality
Editor rating
In development
User likes
0

Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular Evaluate for hypertension

OSA causing pulmonary arterial hypertension

Respiratory Evaluate BMI for decreased FRC

Evaluate OSA status for difficult mask ventilation

Gastrointestinal Consider delayed gastric emptying with diabetes mellitus
Hematologic
Renal
Endocrine Consider delayed gastric emptying with diabetes mellitus
Other

Labs and studies

  • sleep study (AHI score if available) for OSA

Operating room setup

  • Consider ramp for airway management
  • Consider video laryngoscopy
  • OG tube

Patient preparation and premedication

  • Minimize perioperative sedation

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

  • Standard ASA monitors

Induction and airway management

  • Consider rapid sequence induction
  • Video laryngoscopy can be helpful for anticipated difficult airways

Positioning

  • Supine
  • Extreme reverse Trendelenburg (place baseboard by feet)

Maintenance and surgical considerations

  • OG tube is advanced through the surgical anastamosis to prevent backwall suturing of anastamosis
    • Surgical and anesthesia communication and coordination is important to guide OGT through anastamosis

Emergence

Postoperative management

Disposition

  • PACU

Pain management

  • Moderate pain: IV and oral narcotics

Potential complications

  • Bleeding
  • Thromboemobolic events
  • Aspiration
  • Backwall suture of anastamosis

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Jessica Leung, Nirav Kamdar and Chris Rishel

Retrieved from "https://wikianesthesia.org/w/index.php?title=Roux-en-Y_gastric_bypass&oldid=1745"