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Perioperative management of the morbidly obese adolescent with heart failure undergoing bariatric surgery
Author(s) -
Maxwell Bryan G.,
Ingrande Jerry,
Rosenthal David N.,
Ramamoorthy Chandra
Publication year - 2012
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2012.03824.x
Subject(s) - medicine , perioperative , morbidly obese , heart failure , airway management , incidence (geometry) , intensive care medicine , rhabdomyolysis , surgery , airway , obesity , general surgery , anesthesia , weight loss , physics , optics
Summary The incidence and prevalence of adolescent obesity and adolescent heart failure are increasing, and anesthesiologists increasingly will encounter patients with both conditions. A greater understanding of the physiologic challenges of adolescent heart failure as they relate to the perioperative stressors of anesthesia and bariatric surgery is necessary to successfully manage the perioperative risks faced by this growing subpopulation. Here, we present a representative case of a morbidly obese adolescent with heart failure who underwent a laparoscopic bariatric operation and review the limited available literature on perioperative management in this age group. Specifically, we review evidence and offer recommendations related to preoperative evaluation, venous thromboembolism prophylaxis, positioning, induction, airway management, monitoring, anesthetic maintenance, ventilator management, and adverse effects of the pneumoperitoneum, rhabdomyolysis, and postoperative care.