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Update on Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery, 2004–2007
Author(s) -
Schumann Roman,
Jones Stephanie B.,
Cooper Bronwyn,
Kelley Scott D.,
Bosch Mark,
Ortiz Vilma E.,
Connor Kathleen A.,
Kaufman Michael D.,
Harvey Alan M.,
Carr Daniel B.
Publication year - 2009
Publication title -
obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.438
H-Index - 199
eISSN - 1930-739X
pISSN - 1930-7381
DOI - 10.1038/oby.2008.569
Subject(s) - medicine , perioperative , medline , intensive care medicine , cochrane library , best practice , systematic review , evidence based medicine , multidisciplinary approach , dosing , interim , guideline , best evidence , anesthesia , surgery , randomized controlled trial , alternative medicine , social science , history , management , archaeology , pathology , sociology , political science , law , economics
To reevaluate and update evidence‐based best practice recommendations published in 2004 for anesthetic perioperative care and pain management in weight loss surgery (WLS), we performed a systematic search of English‐language literature on anesthetic perioperative care and pain management in WLS published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. We identified relevant abstracts by using key words, retrieved full text articles, and stratified the resulting evidence according to systems used in established evidence‐based models. We updated prior evidence‐based best practice recommendations based upon interim literature. In instances of controversial or inadequate scientific evidence, the task force reached consensus recommendations following evaluation of the best available information and expert opinion. The search yielded 1,788 abstracts, with 162 potentially relevant titles; 45 were reviewed in detail. Despite more information on perioperative management of patients with obstructive sleep apnea (OSA), evidence to support preoperative testing and treatment or to guide perioperative monitoring is scarce. New evidence on appropriate intraoperative dosing of muscle relaxants allows for greater precision in their use during WLS. A novel application of α−2 agonists for perioperative anesthetic care is emerging. Key elements that may enhance patient safety include integration of the latest evidence on WLS, obesity, and collaborative multidisciplinary care into clinical care. However, large gaps remain in the evidence base.