Perioperative Management of Obese Patients

Surgical Clinics of North America

Volumn 95, Issue 2, 2015, Pages 379-390

  Leonard, Kenji L ^a   Davies, Stephen W ^b   Waibel, Brett H ^a  

^a EAST CAROLINA UNIVERSITY   (United States)

^b UNIVERSITY OF VIRGINIA   (United States)

Author keywords

Bariatric surgery; Metabolic syndrome; Morbid obesity; Obesity; Perioperative management; Postoperative care; Preoperative care; Surgery

Indexed keywords

ALPHA ADRENERGIC RECEPTOR STIMULATING AGENT; BARBITURIC ACID DERIVATIVE; BENZODIAZEPINE DERIVATIVE; FENTANYL DERIVATIVE; INHALATION ANESTHETIC AGENT; LOW MOLECULAR WEIGHT HEPARIN; NEUROMUSCULAR BLOCKING AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; OPIATE; ANALGESIC AGENT; ANESTHETIC AGENT;

ACUTE KIDNEY FAILURE; ANESTHESIA; ANESTHESIST; BETA ADRENERGIC RECEPTOR BLOCKING; BLOOD PRESSURE MONITORING; BODY FLUID COMPARTMENT; BODY WEIGHT; CARDIOVASCULAR SYSTEM; COMORBIDITY; DEEP VEIN THROMBOSIS; ELECTIVE SURGERY; ENDOTRACHEAL INTUBATION; EXPIRATORY RESERVE VOLUME; FAT MASS; FORCED EXPIRATORY VOLUME; FUNCTIONAL RESIDUAL CAPACITY; GASTROINTESTINAL TRACT; HOSPITAL PERSONNEL; HUMAN; LEAN BODY WEIGHT; MUSCULOSKELETAL DISEASE; NURSE; NUTRITION; OBESITY; POSITIVE END EXPIRATORY PRESSURE; POSTOPERATIVE ANALGESIA; POSTOPERATIVE PAIN; PRACTICE GUIDELINE; PREOPERATIVE CARE; PRIORITY JOURNAL; REVIEW; SLEEP DISORDERED BREATHING; SURGEON; SURGICAL INFECTION; SURGICAL PATIENT; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; VOLUME OF DISTRIBUTION; COMPLICATION; DOSE RESPONSE; PERIOPERATIVE PERIOD;

ANALGESICS; ANESTHETICS; DOSE-RESPONSE RELATIONSHIP, DRUG; HUMANS; OBESITY; PERIOPERATIVE CARE;

EID: 84925653728     PISSN: 00396109     EISSN: 15583171     Source Type: Journal    
DOI: 10.1016/j.suc.2014.10.008     Document Type: Review

References (73)

1. Flegal K.M., Carroll M.D., Kit B.K., et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012, 307:491-497.
2. Ogden C.L., Lamb M.M., Carroll M.D., et al. Obesity and socioeconomic status in adults: United States, 2005-2008. NCHS Data Brief 2010, 1-8.
3. Kuruba R., Koche L.S., Murr M.M. Preoperative assessment and perioperative care of patients undergoing bariatric surgery. Med Clin North Am 2007, 91:339-351. ix.
4. Livingston E.H. The incidence of bariatric surgery has plateaued in the US. Am J Surg 2010, 200:378-385.
5. Buchwald H., Oien D.M. Metabolic/bariatric surgery worldwide 2008. Obes Surg 2009, 19:1605-1611.
6. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000, 894:i-xii. 1-253.
7. Cullen A., Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological review. Can J Anaesth 2012, 59:974-996.
8. Levin P.D., Weissman C. Obesity, metabolic syndrome, and the surgical patient. Med Clin North Am 2009, 93:1049-1063.
9. Abir F., Bell R. Assessment and management of the obese patient. Crit Care Med 2004, 32:S87-S91.
10. DeMaria E.J., Carmody B.J. Perioperative management of special populations: obesity. Surg Clin North Am 2005, 85:1283-1289. xii.
11. Glance L.G., Wissler R., Mukamel D.B., et al. Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 2010, 113:859-872.
12. Ramchandani L., Belani K. Anesthesia considerations in the obese. Surgical management of obesity 2007, 108-118. Saunders Elsevier, Philadelphia. 1st edition. H. Buchwald, G. Cowan, W.J. Pories (Eds.).
13. Adesanya A.O., Lee W., Greilich N.B., et al. Perioperative management of obstructive sleep apnea. Chest 2010, 138:1489-1498.
14. Al-Benna S. Perioperative management of morbid obesity. JPerioper Pract 2011, 21:225-233.
15. Kaw R., Aboussouan L., Auckley D., et al. Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients. Obes Surg 2008, 18:134-138.
16. Mickelson S.A. Preoperative and postoperative management of obstructive sleep apnea patients. Otolaryngol Clin North Am 2007, 40:877-889.
17. Huschak G., Busch T., Kaisers U.X. Obesity in anesthesia and intensive care. Best Pract Res Clin Endocrinol Metab 2013, 27:247-260.
18. McGlinch B.P., Que F.G., Nelson J.L., et al. Perioperative care of patients undergoing bariatric surgery. Mayo Clin Proc 2006, 81:S25-S33.
19. O'Leary J., Paige J., Martin L. Perioperative management of the bariatric surgery patient. Surgical management of obesity 2007, 119-130. Saunders Elsevier, Philadelphia. 1st edition. H. Buchwald, G. Cowan, W.J. Pories (Eds.).
20. Poirier P., Alpert M.A., Fleisher L.A., et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation 2009, 120:86-95.
21. Servin F. Ambulatory anesthesia for the obese patient. Curr Opin Anaesthesiol 2006, 19:597-599.
22. Porhomayon J., Leissner K.B., El-Solh A.A., et al. Strategies in postoperative analgesia in the obese obstructive sleep apnea patient. Clin J Pain 2013, 29:998-1005.
23. Chand B., Gugliotti D., Schauer P., et al. Perioperative management of the bariatric surgery patient: focus on cardiac and anesthesia considerations. Cleve Clin J Med 2006, 73(Suppl 1):S51-S56.
24. Chakravartty S., Sarma D.R., Patel A.G. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg 2013, 23:1333-1340.
25. Schumann R., Jones S.B., Ortiz V.E., et al. Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery. Obes Res 2005, 13:254-266.
26. Leykin Y., Pellis T., Del Mestro E., et al. Anesthetic management of morbidly obese and super-morbidly obese patients undergoing bariatric operations: hospital course and outcomes. Obes Surg 2006, 16:1563-1569.
27. Pelosi P., Gregoretti C. Perioperative management of obese patients. Best Pract Res Clin Anaesthesiol 2010, 24:211-225.
28. Benotti P., Rodriguez H. Preoperative preparation of the bariatric surgery patient. Surgical management of obesity 2007, 102-107. Saunders Elsevier, Philadelphia. 1st edition. H. Buchwald, G. Cowan, W.J. Pories (Eds.).
29. Murphy C., Wong D.T. Airway management and oxygenation in obese patients. Can J Anaesth 2013, 60:929-945.
30. Schachter L. Respiratory assessment and management in bariatric surgery. Respirology 2012, 17:1039-1047.
31. Mechanick J.I., Youdim A., Jones D.B., et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013, 9:159-191.
32. Tung A. Anaesthetic considerations with the metabolic syndrome. Br J Anaesth 2010, 105(Suppl 1):i24-i33.
33. Katkhouda N., Mason R.J., Wu B., et al. Evaluation and treatment of patients with cardiac disease undergoing bariatric surgery. Surg Obes Relat Dis 2012, 8:634-640.
34. Guss D., Bhattacharyya T. Perioperative management of the obese orthopaedic patient. JAm Acad Orthop Surg 2006, 14:425-432.
35. Apovian C.M., Cummings S., Anderson W., et al. Best practice updates for multidisciplinary care in weight loss surgery. Obesity (Silver Spring) 2009, 17:871-879.
36. Fleisher L.A., Beckman J.A., Brown K.A., et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007, 116:e418-e499.
37. Watson K. Surgical risk in patients with metabolic syndrome: focus on lipids and hypertension. Curr Cardiol Rep 2006, 8:433-438.
38. Lugli A.K., Wykes L., Carli F. Strategies for perioperative nutrition support in obese, diabetic and geriatric patients. Clin Nutr 2008, 27:16-24.
39. Choban P., Dickerson R., Malone A., et al. A.S.P.E.N. clinical guidelines: nutrition support of hospitalized adult patients with obesity. JPEN J Parenter Enteral Nutr 2013, 37:714-744.
40. Jensen M.D., Ryan D.H., Apovian C.M., et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014, 129:S102-S138.
41. Currie A., Chetwood A., Ahmed A.R. Bariatric surgery and renal function. Obes Surg 2011, 21:528-539.
42. Kelz R.R., Reinke C.E., Zubizarreta J.R., et al. Acute kidney injury, renal function, and the elderly obese surgical patient: a matched case-control study. Ann Surg 2013, 258:359-363.
43. Suneja M., Kumar A.B. Obesity and perioperative acute kidney injury: a focused review. JCrit Care 2014, 29:694.e1-694.e6.
44. Thethi T., Kamiyama M., Kobori H. The link between the renin-angiotensin-aldosterone system and renal injury in obesity and the metabolic syndrome. Curr Hypertens Rep 2012, 14:160-169.
45. Thakar C.V., Kharat V., Blanck S., et al. Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol 2007, 2:426-430.
46. Weingarten T.N., Gurrieri C., McCaffrey J.M., et al. Acute kidney injury following bariatric surgery. Obes Surg 2013, 23:64-70.
47. Billings F.T., Pretorius M., Schildcrout J.S., et al. Obesity and oxidative stress predict AKI after cardiac surgery. JAm Soc Nephrol 2012, 23:1221-1228.
48. Bucaloiu I.D., Perkins R.M., DiFilippo W., et al. Acute kidney injury in the critically ill, morbidly obese patient: diagnostic and therapeutic challenges in a unique patient population. Crit Care Clin 2010, 26:607-624.
49. McCullough P.A., Gallagher M.J., Dejong A.T., et al. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest 2006, 130:517-525.
50. Ettinger J.E., Marcilio de Souza C.A., Azaro E., et al. Clinical features of rhabdomyolysis after open and laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008, 18:635-643.
51. Ingrande J., Brodsky J.B. Intraoperative fluid management and bariatric surgery. Int Anesthesiol Clin 2013, 51:80-89.
52. Matot I., Paskaleva R., Eid L., et al. Effect of the volume of fluids administered on intraoperative oliguria in laparoscopic bariatric surgery: a randomized controlled trial. Arch Surg 2012, 147:228-234.
53. Bratzler D.W., Dellinger E.P., Olsen K.M., et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013, 14:73-156.
54. Cardosi R.J., Drake J., Holmes S., et al. Subcutaneous management of vertical incisions with 3 or more centimeters of subcutaneous fat. Am J Obstet Gynecol 2006, 195:607-614. [discussion: 614-6].
55. Kabon B., Nagele A., Reddy D., et al. Obesity decreases perioperative tissue oxygenation. Anesthesiology 2004, 100:274-280.
56. Mullen J.T., Davenport D.L., Hutter M.M., et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol 2008, 15:2164-2172.
57. Wiedemann D., Schachner T., Bonaros N., et al. Does obesity affect operative times and perioperative outcome of patients undergoing totally endoscopic coronary artery bypass surgery?. Interact Cardiovasc Thorac Surg 2009, 9:214-217.
58. Fischer M.I., Dias C., Stein A., et al. Antibiotic prophylaxis in obese patients submitted to bariatric surgery. A systematic review. Acta Cir Bras 2014, 29:209-217.
59. Sturm A.W., Allen N., Rafferty K.D., et al. Pharmacokinetic analysis of piperacillin administered with tazobactam in critically ill, morbidly obese surgical patients. Pharmacotherapy 2014, 34:28-35.
60. Li Z., Bowerman S., Heber D. Health ramifications of the obesity epidemic. Surg Clin North Am 2005, 85:681-701. v.
61. Resources for optimal care of the metabolic and bariatric surgery patient 2014. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program standards and pathway manual. 2014. Available at: Accessed June 1, 2014. http://www.mbsaqip.org/docs/Resources%20for%20Optimal%20Care%20of%20the%20MBS%20Patient.pdf.
62. Davidson J.E., Callery C. Care of the obesity surgery patient requiring immediate-level care or intensive care. Obes Surg 2001, 11:93-97.
63. Hospital-acquired conditions. 2012. Available at: Accessed June 1, 2014. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html.
64. Desciak M.C., Martin D.E. Perioperative pulmonary embolism: diagnosis and anesthetic management. JClin Anesth 2011, 23:153-165.
65. Kehl-Pruett W. Deep vein thrombosis in hospitalized patients: a review of evidence-based guidelines for prevention. Dimens Crit Care Nurs 2006, 25:53-59. [quiz: 60-1].
66. American Society for Metabolic and Bariatric Surgery Clinical Issues Committee ASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis 2013, 9:493-497.
67. Huo M.H., Spyropoulos A.C. The eighth American College of Chest Physicians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies. JThromb Thrombolysis 2011, 31:196-208.
68. Borkgren-Okonek M.J., Hart R.W., Pantano J.E., et al. Enoxaparin thromboprophylaxis in gastric bypass patients: extended duration, dose stratification, and antifactor Xa activity. Surg Obes Relat Dis 2008, 4:625-631.
69. Ludwig K.P., Simons H.J., Mone M., et al. Implementation of an enoxaparin protocol for venous thromboembolism prophylaxis in obese surgical intensive care unit patients. Ann Pharmacother 2011, 45:1356-1362.
70. Rondina M.T., Wheeler M., Rodgers G.M., et al. Weight-based dosing of enoxaparin for VTE prophylaxis in morbidly obese, medically-Ill patients. Thromb Res 2010, 125:220-223.
71. Singh K., Podolsky E.R., Um S., et al. Evaluating the safety and efficacy of BMI-based preoperative administration of low-molecular-weight heparin in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg 2012, 22:47-51.
72. Shamian B., Chamberlain R.S. The role for prophylaxis inferior vena cava filters in patients undergoing bariatric surgery: replacing anecdote with evidence. Am Surg 2012, 78:1349-1361.
73. Vaziri K., Devin Watson J., Harper A.P., et al. Prophylactic inferior vena cava filters in high-risk bariatric surgery. Obes Surg 2011, 21:1580-1584.