Difference between revisions of "Roux-en-Y gastric bypass"
From WikiAnesthesia
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A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an anastamosis to the jejunum to drain the proximal pouch. | |||
==Preoperative management== | ==Preoperative management== | ||
| Line 50: | Line 50: | ||
===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. -->=== | ===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. -->=== | ===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 ramp for airway management | ||
* Consider video laryngoscopy | *Consider video laryngoscopy | ||
* OG tube | *OG tube | ||
===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | ===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | ||
* Minimize perioperative sedation | *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. -->=== | ===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. -->=== | ||
| Line 68: | Line 68: | ||
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->=== | ===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 | *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. -->=== | ===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 | *Consider rapid sequence induction | ||
* Video laryngoscopy can be helpful for anticipated difficult airways | *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. -->=== | ===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ||
* Supine | *Supine | ||
* Extreme reverse Trendelenburg (place baseboard by feet) | *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. -->=== | ===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 | *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 | **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. -->=== | ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ||
| Line 91: | Line 91: | ||
===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ||
* PACU | *PACU | ||
===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ||
* Moderate pain: IV and oral narcotics | *Moderate pain: IV and oral narcotics | ||
===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ||
* Bleeding | *Bleeding | ||
* Thromboemobolic events | *Thromboemobolic events | ||
* Aspiration | *Aspiration | ||
* Backwall suture of anastamosis | *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). -->== | ==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). -->== | ||
Revision as of 12:09, 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 | |
| User likes | 0 |
A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an anastamosis to the jejunum to drain the proximal pouch.
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