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.