Anesthesia for Bariatric Surgery

New York Bariatrics recognizes the vital importance of skilled anesthesia in the performance of Bariatric surgery.  All of Dr. Weber’s Bariatric patients are assessed and treated by a Board Certified M.D. Anesthesiologist, who is part of the Bariatric surgery team and who has long-standing experience and interest in Bariatric surgery.  Close cooperation with the anesthesiologist and Dr. Weber allows for a smooth transition through surgery

The anesthesia process begins with the preoperative work-up.  Since weight loss surgery is “elective” (rather than emergency), much attention is paid to getting a thorough medical evaluation and to having all associated medical conditions under optimal control prior to surgery.  Of particular interest to the anesthesiologist are the following:

o       Respiratory:

 The combination of morbid obesity, general anesthesia, and upper abdominal surgery places a large stress on the respiratory (breathing) system.  Other pulmonary conditions, therefore, need to be identified and treated as fully as possible.  Some of these problems are emphysema, asthma, and sleep apnea.  Sleep apnea is a common problem in morbid obesity.  It can be associated with possible airway difficulties and increased sensitivity to sedatives and painkillers.  Smoking is another problem for general anesthesia.  Cessation of smoking for even a few weeks can improve respiratory function and provide for a smoother anesthetic course.

o       Cardiac:

Morbid obesity is associated with an increased incidence of atherosclerosis and heart disease.  Again, any related problems should be identified and optimized before surgery.

o       Hypertension: 

Good treatment and control of high blood pressure leads to a smoother anesthetic course.  Most medications can be continued up to and including the day of surgery.

o       Diabetes:

Diabetes conditions should be identified and brought under control pre-operatively.

o       Esophageal Reflux:

Medications for this condition should be continued to prevent any aspiration of acidic gastric contents.

All medications should be reviewed with the medical consultant to determine whether they should be continued up to the time of surgery. Some medicines such as MAO inhibitors and Serzone may need to be stopped up to two weeks prior to surgery.  Many “herbal” remedies are in fact potent medicines and can interact negatively with drugs given in the perioperative period.  These should be stopped prior to surgery.  Many of the conditions outlined above are often dramatically improved following successful Bariatric surgery, and are frequently the indications for the surgery in the first place.

During the preoperative phase, patients who have had problems with anesthesia in the past 5-7 years should make an effort to obtain the anesthesia record from those procedures.

The next phase of anesthesia is the day of surgery.  At this time the patient is interviewed and examined by the anesthesiologist.  The patient is encouraged, however, to meet the anesthesiologist either by telephone or in person prior to the day of surgery.  Dr. Weber provides this information to the patient on their initial meeting.  On the morning of surgery, most patients are given an injection of a “drying agent” and an oral antacid.  An IV line is placed and sedation is often given in the holding area.  Patients are closely monitored non-invasively with EKG, capnometry, pulse oximetry and Bis (awareness).  Rarely, is there a need for more invasive monitoring.

All Bariatric Surgeries are performed under general anesthesia with endotracheal intubation.  The endotracheal tube is placed either under topical anesthesia and intravenous sedation or after the induction of general anesthesia.  The method is at the discretion of the anesthesiologist and depends on the patient’s medical history and anatomy. It should be noted, however, that historically either method has been well accepted by our patients.  The anesthesiologist is highly skilled at either method.

Anesthesia is maintained during surgery by a combination of inhalation and intravenous agents.  At the end of surgery the patient is allowed to awaken and breathe spontaneously.  Usually the endotracheal tube is removed in the operating room.  It may be necessary at times, however, to leave the endotracheal in place at the end of surgery, to be removed later when conditions are more optimal.

The patient is then transferred to the PACU (Post Anesthesia Care Unit, or “recovery room”).  Monitoring of vital signs is continued and pain control is started with intravenous agents and maintained with patient controlled analgesia (PCA).  Oxygen and breathing treatments are given as needed. The patient is then transferred to the surgical floor for the remainder of the hospital stay.

For additional information about anesthesia, please call us (914) 948-1000.

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