Bariatric surgery: Intensive care unit management of the complicated postoperative patient
- Kevin Thornton, MD
Kevin Thornton, MD
- Assistant Clinical Professor of Anesthesia
- University of California San Francisco School of Medicine
- Richard H Savel, MD, FCCM
Richard H Savel, MD, FCCM
- Professor of Clinical Medicine
- Albert Einstein College of Medicine
- Michael A Gropper, MD, PhD
Michael A Gropper, MD, PhD
- Professor and Chair
- Department of Anesthesia and Perioperative Care
- University of California, San Francisco
- Section Editors
- Daniel Jones, MD
Daniel Jones, MD
- Section Editor — Bariatric and Metabolic Surgery
- Professor of Surgery
- Harvard Medical School
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
Most obese patients with uncomplicated medical comorbidities following a bariatric operation are managed on the standard in-patient postoperative surgical unit. However, patients with severe obesity (body mass index >60 kg/m2) and/or severe comorbid illnesses (eg, refractory diabetes) may require intensive care unit (ICU) management prior to transfer to the in-patient surgical floor [1-7]. Parallels can be drawn from the management of the complicated postoperative patient undergoing a bariatric operation and applied to management of a complicated postoperative obese patient undergoing a different elective operation.
The intensive care unit management of the complicated postoperative bariatric surgical patient will be reviewed here. A description of specific bariatric operations, indications for surgery, short-term and long-term complications and outcomes, morbidity and mortality, and management of the uncomplicated postoperative patient are reviewed as separate topics, including:
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- CRITERIA FOR ICU ADMISSION
- INTENSIVE CARE UNIT POSTOPERATIVE MANAGEMENT
- Cardiac and hemodynamic monitoring
- Respiratory management
- - Extubation
- - Ventilation management
- - Prolonged ventilation and ICU admission
- Mechanical ventilation
- Noninvasive positive pressure ventilation
- Role of tracheostomy
- Vascular access
- Pain control
- Glycemic control
- Repositioning maneuvers
- Prophylaxis for venous thromboembolic events
- MEDICATION DOSING
- Antibiotic dosing
- Sedative and analgesic dosing
- Neuromuscular blocking agent dosing
- Anticoagulant dosing
- - Unfractionated heparin
- - Low molecular weight heparins
- Cardiac medication dosing
- RISK OF COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS