Roux-en-Y gastric bypass

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
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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

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

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

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