Anesthesia for Bariatric Surgery

For those battling obesity, bariatric surgery is a proven medical solution for achieving long-term weight loss. While bariatric surgery has become an increasingly common and safe operation, it is still considered major surgery with short and long-term side effects. 

Anesthesia for bariatric surgery is necessary and plays a major role in the surgery procedure.

What should bariatric patients expect from anesthesia and what type of anesthesia is used?

We will explore all of this in the guide below to help prospective bariatric patients prepare for their operation.

 

What Type of Anesthesia is Used for Bariatric Surgery?

Bariatric surgery is considered a major operation. 

For this reason, general anesthesia is used. This means that the patient is fully unconscious throughout the entire procedure. 

There are various different types of bariatric surgery available. Common procedures include:

  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Biliopancreatic diversion with duodenal switch

The course of anesthesia will depend on the individual circumstances.

 

Anesthesia Practices for Bariatric Surgery

When it comes to anesthesia for bariatric surgery, inhaled anesthetic medications are often preferred. 

Strict anesthesia protocol for bariatric surgery is important because there are greater complications involved in anesthesia with obese patients. 

Larger doses of anesthesia induction agents are required for obese individuals, but obese patients are also more sensitive when it comes to these agents. 

This is why anesthesia practice for bariatric surgery needs to follow a strict pre-operative process to determine the best practices for the individual, as well as thorough post-operative care. 

 

Maintenance of the Anesthetic Technique

Anesthesia for bariatric surgery is generally done through intubation by direct laryngoscopy. 

Intubation is most common, however for those experiencing difficulties fiber-optic intubation may be required. Some patients may experience the aspiration of gastric contents if there is insufficient intubation.

The anesthetic technique varies between individual patients and cases

Bariatric patients are uniquely challenging for anesthetists and methods can vary between patients to ensure the safest and most effective procedure. 

Is There a Weight Limit for Anesthesia?

While obese patients do have a greater risk of complications regarding anesthesia, there is no weight limit for anesthesia. 

If the patient's BMI is over 30, which is considered obese, there is a greater risk involved with anesthesia. 

A liver reduction diet is generally recommended before bariatric surgery in order to decrease the size of the liver. This can help the surgeon gain better access to the stomach and decrease surgical complications. This liver reduction diet can result in weight loss before surgery which can also decrease some complications regarding anesthesia and surgical difficulties. 

The greatest concern around anesthesia for obese patients is a condition called sleep apnea. This is when patients can momentarily stop breathing while being asleep. General anesthesia can cause concern regarding oxygen and airflow for patients with sleep apnea.

Sleep apnea and bariatric surgery can cause a high risk of complications both during the operation and postoperative. This is why obstructive sleep apnea syndrome (OSA) screening needs to be done before anesthesia methods are considered. 

Bariatric surgery is a effective tool for significant weight loss in the obese population. Potential complications of weight and surgery are taken into consideration. Anesthesia for bariatric surgery is considered a safe process, as this is a fairly common procedure. 

Do Obese Patients Need More Anesthesia?

Obesity can affect the metabolism of certain drugs including anesthetic agents.

Anesthetic drugs are generally dosed based on body weight. So in this sense yes, obese patients will likely require a higher dose of anesthetic drugs. 

Dosing will be properly decided between the anesthetist and surgical team to ensure your safety.

General Anesthesia for Gastric Bypass Surgery

Gastric bypass is one of the most common bariatric surgery procedure types. This procedure does require a general anesthetic. The patient is not awake while the surgery is performed, so no pain will be felt. 

When anesthesia for bariatric surgery is done, patients will be connected to machines that monitor vital signs. Respirators are also used to assist with breathing while under anesthesia. 

However, in some cases, it is possible to undergo laparoscopic bariatric surgery under epidural anesthesia. This is not a particularly common procedure, and the vast majority of bariatric surgery patients will go through a general anesthetic.

 

Anesthesia for Bariatric Surgery Considerations

There are various anesthetic considerations for patients presenting with bariatric surgery. 

Because of the complications that are present around obesity and anesthesia, preoperative evaluations, as well as postoperative management is important.

Preoperative Evaluation

Bariatric surgery patients require certain pre-operative tests and clearances. This includes things like consulting with the anesthesiologist, going through a sleep study, and certain lab work. 

A thorough preoperative evaluation is essential to make sure that the right candidates are chosen for bariatric surgery. 

Preoperative evaluations also help to enhance the success of the surgery procedure. 

Intraoperative Considerations

Anesthetists need to go through a thorough assessment process of each patient in order to reduce any risks related to anesthesia for bariatric surgery. 

As mentioned earlier, carefully monitoring the patient's vital signs and using respirators during surgery is important. 

Postoperative Management

Discharge from the hospital can take up to 4-6 days after surgery due to monitoring efforts and pain management. This allows some time for the gastrointestinal tract to start healing properly. Usually, patients will be discharged from the hospital on a full liquid diet. 

Most bariatric practitioners will recommend starting post-bariatric surgery supplements to help with the recovery process and prevent deficiencies. Vitamins for bariatric patients are an important step in order to assist the body in receiving the proper nutrition during the recovery period and for life-long success. 

 

Bariatric Surgery Anesthesia in Children

Bariatric surgery in morbidly obese children can be performed to provide maximum benefits with low risk. 

The most common bariatric procedures in adolescents include a Roux-en-Y gastric bypass and vertical sleeve gastrectomy.

Anesthesia for bariatric surgery in children is carefully considered, with anesthesia doses being properly adjusted to meet the patient's body weight. 

 

Non-Surgical Bariatric Weight Loss

Non-surgical weight-loss options are available and can be beneficial in certain cases. This includes the gastric balloon procedure. 

Anesthesia is not required for this procedure. The doctor will provide you with a mild sedative to reduce discomfort during insertion. An endoscope will be guided through the mouth to insert the balloon into the stomach.

The gastric balloon procedure is based on the idea of making you feel full quickly to avoid overeating. The balloon takes up about ⅔ of stomach space; thus, you’ll reach satiety after consuming a smaller amount of food.

 

Post-Bariatric Surgery Considerations

Plastic Surgery

Post-bariatric plastic surgery is a consideration for patients after weight loss surgery. Reconstructive plastic surgery may be required for patients with loose skin that is causing complications, like irritation and infection. 

Bariatric Surgery and Diabetes

One of the benefits of bariatric surgery includes improvements in type 2 diabetes. Some weight loss surgeries have shown to produce a long-term remission of the disease. 

Bariatric Surgery Benefits

There are numerous bariatric surgery benefits that patients can experience. 

This may include:

  • Decreased risk of Obstructive Sleep Apnea
  • Improved cardiovascular health
  • Relief of joint pain 
  • Increased fertility
  • Improved quality of life and mental health

Bariatric Surgery Support Groups

Bariatric surgery can be life changing and the last thing you want to do is go through your weight loss journey alone.

    In the long run, following a support group for bariatric surgery patients will help remind you of why you chose surgery in the first place, how hard it was, and everything you went through to reach your optimal weight.

    All bariatric patients require support and encouragement throughout the journey. Support can come from family, friends, healthcare providers and individuals who have been also been through bariatric surgery.

    Utilize the resources available to you. Don't let excuses and barriers get in your way of success. 

     

    Conclusion

    Anesthesia for bariatric surgery can be particularly complicated due to the various risks involved in regards to obese patients. Patients typically require general anesthesia for bariatric surgery operations. 

    While this surgery has become a fairly common and low-risk procedure, anesthetists need to pay special attention to obese patients. This includes careful preoperative assessments, as well as thorough post-operative care to avoid certain risk factors involved in the operation. 

    Consider checking: Bariatric Surgery Hospital Checklist

     

    **This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your physician or another qualified health provider with any questions in regards to a medical condition.