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
In development
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