The use of extraluminal AEB or mainstem intubation for OLV can be successfully completed in infants weighing less than 10 kg. OLV may induce acute respiratory pathology; therefore we recommend routine intraoperative ABG monitoring for pediatric patients.

Abstract:Background: There are considerable implications for pain management in morbidly obese patients undergoing weight loss operations. The purpose of this study was to determine if a modified postoperative analgesic regimen and a dedicated postoperative bariatric team reduced pain scores, length of stay and postoperative complications. Materials and Methods:We performed a retrospective analysis of morbidly obese patients admitted to our medical center for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). Our previous postoperative pain regimen was ketorolac (30 mg IV plus 15 mg q6h) and patient controlled analgesia (PCA) morphine and was converted to ketorolac (30 mg IV and 30 mg i.m, plus 15 mg q6h), and IV PCA hydromorphone. Visual analog scale (VAS) pain scores from the post-operative care unit were collected retrospectively. The bariatric team was led by a nurse practitioner consisted of a psychologist, exercise physiologist, and nutritionist.Results: Eighty-five patients underwent bariatric operations in the year prior to implementation of the revised postoperative pain management regimen and 372 patients underwent bariatric surgery in the 2 years following implementation. Patient age, gender and BMI were evenly distributed for both groups. Mean VAS scores on postoperative days 1 through 5 were significantly lower after implanting our modified pain regimen (p<0.0001). Pain scores were significantly higher for patients that underwent LRYGB compared to LAGB (p<0.0001). Overall, length of hospital stay was unaffected by the new pain regimen, however a significant reduction was found in patients that underwent LAGB (0.8 days less; p=0.0001). Conclusion:Use of our modified pain regimen resulted in a more effective analgesic protocol and a reduction of hospital stay, without added complications or side effects.

Reports of acute onset of Guillain-Barré syndrome (GBS) after epidural anesthesia/analgesia after labor and cesarean delivery has raised concern of a correlation between GBS and the use of neuraxial anesthesia. We present a patient who developed bilateral lower extremity weakness and paraparesis within hours after removal of an epidural catheter for cesarean delivery. The clinical diagnosis was highly suggestive for GBS after magnetic resonance imaging, cerebrospinal fluid findings, electromyogram, and nerve conduction studies. We discuss the pathophysiological mechanisms suggested in previous case reports and describe the relationship between epidural analgesia and GBS.