Bariatric Surgery Patients
First Things First (assess & treat for the following)
- These are not general surgery patients.
- They have little reserve.
- They can get very sick, very quickly.
- Often exhibit very subtle signs and symptoms of serious problems
- Prepare for challenges with
- Difficult airways
- Line access
- Barriers to diagnostic tests
- Tachycardia of >120 beats/min for >4 hours means anastomotic leak until proven otherwise in the early postop period.
- Contact pt’s bariatric surgeon early to obtain history and surgical details.
- Obtain surgical consult early, preferably surgeon with bariatric surgery experience.
- The majority of life-threatening postop events will be surgical in nature and must be ruled out first, even if that means re-operation.
- Most common surgical complications are leak, obstruction and bleeding.
- Radiologic tests to rule out leaks are only 70% sensitive.
- These patients are at risk for thiamine deficiency, so give thiamine and MVI prior to glucose.
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