Update on Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery, 2004–2007 |
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| Authors: | Roman Schumann Stephanie B Jones Bronwyn Cooper Scott D Kelley Mark Vanden Bosch Vilma E Ortiz Kathleen A Connor Michael D Kaufman Alan M Harvey Daniel B Carr |
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| Institution: | 1. Department of Anesthesia, Tufts‐New England Medical Center, Boston, Massachusetts, USA;2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;3. Department of Anesthesiology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA;4. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA;5. Department of Anesthesiology, Berkshire Health Systems, Pittsfield, Massachusetts, USA;6. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA;7. Department of Anesthesiology, Newton‐Wellesley Hospital, Newton, Massachusetts, USA;8. Department of Anesthesiology, The Lahey Clinic, Burlington, Massachusetts, USA |
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| Abstract: | 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. |
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