Morbid Obesity: Peri-Operative Management

435 Pages·2004·3.91 MB·English

by  Adrian O. Alvarez

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MORBID OBESITY
PERI-OPERATIVE MANAGEMENT
Dr Adrian O. Alvarez is at present one ofthe most recognized experts in the anesthetic management ofthe mor-
bidly obese patient in the world. Being an anesthesiologist and also general surgeon he early recognized the
importance of the multidisciplinary approach to these kind ofindividuals. He has been working in this scenario
in close relationship with experts of other fields (bariatric surgeons, internists, nutritionists) since many years
ago, and this spirit is clearly reflected in this work “Morbid Obesity, Perioperative Management”.
MORBID OBESITY
PERI-OPERATIVE MANAGEMENT
Editor in Chief
Adrian O. Alvarez
Medical Director, IMETCO (Instituto Multidisciplinario Especializado
en el Tratamiento y Cirugía de la Obesidad), Buenos Aires, Argentina
Associate Editors
Jay B. Brodsky
Professor, Department ofAnesthesia, Stanford University School of
Medicine, Stanford, CA, USA
Martin A. Alpert
Chairman, Department ofMedicine, St. John’s Mercy Medical Center,
St. Louis, Missouri, MO, USA
Clinical Professor ofMedicine, University ofMissouri School of
Medicine, Columbia, MO, USA
George S.M. Cowan Jr.
Professor Emeritus, University ofTennessee, Memphis, TN, USA
Past-President, International Federation for the Surgery of
Obesity (IFSO)
Past-President, American Society for Bariatric Surgery (ASBS)
Founder, Obesity Surgery Journal
CAMBRIDGE UNIVERSITY PRESS
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Cambridge University Press
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Published in the United States of America by Cambridge University Press, New York
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© Cambridge University Press 2004
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without the written permission of Cambridge University Press.
First published in print format 2004
ISBN-13 978-0-511-26480-1 eBook (EBL)
ISBN-10 0-511-26480-1 eBook (EBL)
ISBN-13 978-1-841-10188-0 hardback
ISBN-10 1-841-10188-5 hardback
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CONTENTS
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
M. Deitel
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
J.B. Brodsky
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Section 1 General aspects ................................................................................................................ 1
1. Introduction to peri-operative management: reasons for a multidisciplinary approach . . . . . . . . . . . . 3
A.O. Alvarez & A. Baltasar
2. Peri-operative risks and frequent complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
L. Brusco Jr.
3. Informed consent in bariatric surgery and anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
G.S.M. Cowan Jr.
Section 2 Pathophysiology ............................................................................................................... 43
4. Lung physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
M.A. Campos & A. Wanner
5. Cardiac morphology and ventricular function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
M.A. Alpert
6. Pathophysiology ofcardiovascular co-morbidities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
T.J.J. Blanck, I. Muntyan & H. Zayed-Moustafa
7. Physiological changes during laparoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
M. Fried
8. Digestive physiology and gastric aspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
P. Marko, A. Gabrielli, L.J. Caruso & A.J. Layon
Section 3 Pre-operative management ............................................................................................. 111
9. Pre-operative evaluation ofthe patient for bariatric surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
R.A. Beers & M.F. Roizen
Section 4 Peri-operative management ofco-morbidities ............................................................. 129
10. Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
F.G. Mihm
11. Co-existing cardiac disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
S. Akhtar, V. Kurup & L. Helgeson
12. Deep venous thrombosis prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
C.A. Barba& F.N. Lamounier
13. Surgical antibiotic prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
A. Lepetic, C. Vujacich, A. Calmaggi, G.M. Guerrini & M.d.R.G. Arzac
vi CONTENTS
14. Renal dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
D.M. Rothenberg & A. Rajagopal
Section 5 Pharmacology .................................................................................................................. 209
15. Pharmacokinetics and pharmacodynamics: essential guide for anesthetic drugs administration . . . . . 211
L.E.C. De Baerdemaeker, E.P. Mortier & M.M.R.F. Struys
16. Remifentanil in morbidly obese patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
A.O. Alvarez
Section 6 Monitoring ........................................................................................................................ 241
17. Electrocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
M.A. Alpert
18. Respiratory monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
M. Tucci, V. Bansal & E.M. Camporesi
19. Cortical electrical activity monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
G.M. Gurman
Section 7 Intra-operative management .......................................................................................... 271
20. Positioning the morbidly obese patient for surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
J.B. Brodsky
21. Airway management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
A.P. Reed & D.C. Kramer
22. Inhalational anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
L.H. Hanowell
23. Total intravenous anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
A.O. Alvarez
24. Anesthetic management for the obese parturient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
J.T. Sullivan & C.A. Wong
Section 8 Post-operative care .......................................................................................................... 337
25. Post-anesthetic care unit management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
J.C. Flores
26. Respiratory management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
E. Fam & P.E. Marik
27. Management ofthe obese critically ill patient in intensive care unit . . . . . . . . . . . . . . . . . . . . . . . . . . 363
P.E. Marik & F. Brun
28. Nursing management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
S.M. Burns, D. Charlebois, M. Deivert, J. Krenitsky & D. Wilmoth
29. Post-operative analgesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
A.G. Haidbauer
Section 9 Conclusions ...................................................................................................................... 397
30. Anesthesia and morbid obesity: present and future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
A.O. Alvarez
Afterword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
A.O. Alvarez &G.S.M. Cowan Jr.
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
CONTRIBUTORS
Shamsuddin Akhtar University ofConnecticut
Department ofAnesthesiology CT, USA
Yale University School ofMedicine
Boston, MA, USA
R.A. Beers
Department ofAnesthesia
Alejandro Lepetic
State University ofNew York Upstate Medical
Fundación Centro de Estudios Infectológicos
University
(FUNCEI)
Syracuse, NY, USA
Buenos Aires, Argentina
Martin A. Alpert Thomas J.J. Blanck
Chairman, Department ofMedicine Professor and Chairman
St. John’s Mercy Medical Center Department ofAnesthesiology
St. Louis, Missouri, MO, USA New York University Medical Center
Clinical Professor ofMedicine NY, USA
University ofMissouri School ofMedicine
Columbia, MO, USA Jay B. Brodsky
Professor, Department ofAnesthesia
María del Rosario González Arzac
Stanford University School ofMedicine
Hospital Interzonal de Agudos
Stanford, CA, USA
Prof. Dr. Rodolfo Rossi
La Plata, Buenos Aires, Argentina
Francisco Brun
Luc E.C. De Baerdemaeker Critical Care Fellow
StaffAnesthesiologist University ofPittsburgh
Ghent University Hospital Pittsburgh, PA, USA
Gent, Belgium
Louis Brusco Jr.
Aniceto Baltasar
Assistant Professor ofClinical Anesthesiology
Chairman, Department ofSurgery
Columbia University
Hospital Virgen de los Lirios
College ofPhysicians and Surgeons
Alcoy, Spain
Associate Medical Director
Past-President
St. Luke’s-Roosevelt Hospital Center
International Federation for the Surgery
New York, NY, USA
ofObesity (IFSO)
Director
Critical Care Anesthesiology
Vipin Bansal
Co-Director
Resident, Department ofAnesthesiology
Surgical Intensive Care Unit
Upstate Medical University
St. Luke’s-Roosevelt Hospital Center
Syracuse, NY, USA
New York, NY, USA
Carlos A. Barba
Medical Director Suzanne M. Burns
Center for Bariatric Surgery Professor ofNursing (APN 2)
Saint Francis Hospital and Medical Center MICU
Associate Professor ofSurgery McLeod Hall School ofNursing
Traumatology and Emergency Medicine Charlottesville, VA, USA
viii CONTRIBUTORS
Aníbal Calmaggi Universidad de Buenos Aires
Unidad de Transplante de Médula Ósea Argentina
Hospital Interzonal de Agudos Prof. Dr. Rodolfo Past-President
Rossi. La Plata Federación Argentina de Asociaciones de
Buenos Aires, Argentina Anestesiologia
Argentina
Enrico M. Camporesi
Professor and Chairman Martin Fried
Department ofAnesthesiology Associate Professor ofSurgery
Upstate Medical University 1st Medical Faculty
Syracuse, NY, USA Charles University
Prague, Czech Republic
Michael A. Campos
Chiefsurgeon
Assistant Professor ofMedicine
Obesity Treatment Center
Division ofPulmonary and Critical Care Medicine
Prague, Czech Republic
University ofMiami School ofMedicine
Past-President
FL, USA
International Federation for the Surgery of
Obesity (IFSO)
Lawrence J. Caruso
Associate Professor ofAnesthesiology
Andrea Gabrielli
University ofFlorida College ofMedicine
Associate Professor ofAnesthesiology and Surgery
Gainesville, FL, USA
University ofFlorida College ofMedicine
Gainesville, FL, USA
Donna Charlebois
Pulmonary Transplant Coordinator and APN 1
Graciela M. Guerrini
University ofVirginia Health System
Unidad de Transplante de Médula Ósea
Charlottesville, VA, USA
Hospital Interzonal de Agudos Prof. Dr. Rodolfo Rossi
La Plata, Buenos Aires, Argentina
George S.M. Cowan Jr.
Professor Emeritus
Gabriel M. Gurman
University ofTennessee
Division ofAnesthesiology, Ben Gurion University
Memphis, TN, USA
ofthe Negev, Faculty ofHealth Sciences,
Past-President
Soroka Medical Center, Beer Sheva, Israel
International Federation for the Surgery of
Obesity (IFSO) Alejandro G. Haidbauer
Past-President Vice-Chairman
American Society for Bariatric Surgery (ASBS) Anesthesiology Department
Founder, Obesity Surgery Journal Hospital Alemán
Buenos Aires, Argentina
Mervyn Deitel
Editor-in-Chief, Obesity Surgery Leland H. Hanowell
Past Executive Director, Department ofAnesthesia
International Federation for the Surgery ofObesity Stanford University School ofMedicine
Toronto, Canada Stanford, CA, USA
Mary Deivert Lars Helgeson
Trauma Care Coordinator Department ofAnesthesiology
University ofVirginia Health System Yale University School ofMedicine
Charlottesville, VA, USA Boston, MA, USA
Ezz Fam David C. Kramer
Critical Care Fellow Assistant Professor ofAnesthesiology
University ofPittsburgh School ofMedicine Mount Sinai School ofMedicine
Department ofCritical Care New York, NY, USA
Pittsburgh, PA, USA
Joe Krenitsky
Juan C. Flores Clinical Nutritionist
Chairman, Anesthesia Department University ofVirginia Health System
Hospital de Clinicas Jose de San Martin Charlottesville, VA, USA