By Daniel M. Herron
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Additional info for Bariatric Surgery Complications and Emergencies
Selzer 34 tive defense mechanism against sleep apnea that helps in overcoming the airway obstruction. Furthermore, coexisting illnesses such as systemic hypertension, insulin resistance, coronary artery disease, and cardiac arrhythmias render the perioperative management of these patients even more complicated. A recent meta-analysis assessing the risk of sleep apnea on postoperative complications concluded that the incidence of oxygen desaturations, respiratory failure, cardiac events, and ICU transfers was higher in patients with OSA .
4 % based on a retrospective review of the Bariatric Outcomes Longitudinal Database (BOLD) database comprising of 78,951 bariatric surgical patients . History of smoking greater than 20 pack-years has been demonstrated to be associated with elevated risk of postoperative respiratory complications . Early ambulation and incentive spirometry in the immediate postoperative period are important in decreasing the incidence of pulmonary complica- 3 Optimizing Perioperative Management: Perioperative Care and Protocols… tions.
Patients undergoing bariatric surgery require close monitoring in the post-anesthesia care unit (PACU). Even though the literature is insufﬁcient to offer guidance regarding the appropriate duration of postoperative respiratory monitoring, continuous monitoring should be maintained as long as patients remain at increased risk. The proper postoperative respiratory management plan should include monitoring, avoiding supine position, supplemental oxygen, respiratory therapy, multimodal pain management, and use of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) for OSA patients.