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2016, Number 1

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Rev Mex Anest 2016; 39 (1)

Bariatric surgery. Cardiopulmonary anesthetic considerations in laparoscopic gastric bypass

Gómez-Ríos N, Rodríguez-Ortega F, Lozano-Corona R, Victoria-Campos JL, Negrete-Rivera MA, Fernández-Rivera BJ

Language: Spanish
References: 164
Page: 30-49
PDF size: 319.24 Kb.


ABSTRACT

Objective: To report the anesthetic management and perioperative cardiopulmonary complications in morbidly obese patients treated with laparoscopic gastric bypass. Setting: Medical Center of «Instituto de Seguridad Social del Estado de México y Municipios». Design: Retrospective, observational, longitudinal, descriptive. Statistical analysis: Percentages as summary measure for qualitative variables. Material and methods: Between June of 2009 to June 2015, clinical records of the 116 patients diagnosed with morbid obesity and bariatric surgery candidates selected to perform a laparoscopic gastric bypass were reviewed, analyzed variables were: age and gender, anesthetic treatment, cardiopulmonary complications, morbidity and mortality. Results: 116 patients were included in the study, 92 female gender; age, weight and body mass index average of 40 years, 124.4 kg and 45.5 kg/m2. The following comorbidities: systemic arterial hypertension 71 patients and diabetes mellitus 70. It was used continuous positive airway pressure in four. Using scales OBESE, OS-MRS, STOP-BANG and HAN for anesthetic preoperative assessment. As for the pre-anesthetic propofol treatment was administered in 109 patients, fentanyl 101, rocuronium 32 and sevofluorane 93. Futhermore; laryngeal mask airways (Fastrach®) is used in four patients and fiberoptic bronchoscope in seven. In the trans and postoperative period 49 patients with arrhythmias and atelectasis in 41 were diagnosed. In the postoperative period antagonism was performed in 12 patients with neostigmine and continuous positive airway pressure was used in 8 (4 preoperative and 4 postextubation); orotraqueal reintubation in 4 patients in operating room. Local anesthetic infiltration 100% at the incision site. With satisfactory anesthetic evolution to 12 moths follow up. Conclusion: The increse in operating room of these patients requires the adequate preparation of the anesthesiologist, for intensive and multidisciplinary treatment.


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