Difference between revisions of "Roux-en-Y gastric bypass"
From WikiAnesthesia
(started the page. Added patient evaluation. Edited pre-operative and intraoperative management.) |
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OG tube | OG tube | ||
| monitors = Standard, nasal temp | | monitors = Standard, nasal temp | ||
| considerations_preoperative = Potential difficult airway | | considerations_preoperative = Potential difficult ventilation and airway management | ||
| considerations_intraoperative = Rapid sequence, ramped position | | considerations_intraoperative = Rapid sequence, ramped position | ||
| considerations_postoperative = PONV, IV tylenol | | considerations_postoperative = PONV, IV tylenol | ||
}} | }} | ||
A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an | A procedural variant for gastric partitioning for morbid obesity where the stomach is partitioned into a proximal and distal pouch with an anastomosis to the jejunum to drain the proximal pouch. | ||
==Preoperative management== | ==Preoperative management== | ||
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*Consider video laryngoscopy | *Consider video laryngoscopy | ||
*OG tube | *OG tube | ||
*Methylene Blue and 60mL syringe | |||
===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. -->=== | ||
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===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. -->=== | ||
* Consider post-operative TAP block | |||
==Intraoperative management== | ==Intraoperative management== | ||
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===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 | *OG tube is advanced through the surgical anastomosis to prevent backwall suturing of anastomosis | ||
**Surgical and anesthesia communication and coordination is important to guide OGT through | **Surgical and anesthesia communication and coordination is important to guide OGT through anastomosis | ||
*Methylene blue 60mL used at the end of the case to pressurize the proximal pouch and look for leaks across the staple line of the anastomosis. | |||
===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. -->=== | ||
Revision as of 13:34, 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 ventilation and airway management |
| 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 anastomosis 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
- Methylene Blue and 60mL syringe
Patient preparation and premedication
- Minimize perioperative sedation
Regional and neuraxial techniques
- Consider post-operative TAP block
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 anastomosis to prevent backwall suturing of anastomosis
- Surgical and anesthesia communication and coordination is important to guide OGT through anastomosis
- Methylene blue 60mL used at the end of the case to pressurize the proximal pouch and look for leaks across the staple line of the anastomosis.
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