Airway management concerns in patient with gastric banding procedures

Abstract

Laparoscopic adjustable gastric band (LAGB) is considered a relatively safe and effective treatment for obesity. Even after weight loss patients with LAGB are at increased risk of pulmonary aspiration during induction of general anaesthesia, possibly due to LAGB-induced anatomical and functional changes. We present a case of aspiration in a patient with LAGB following significant weight loss and 14 h of preoperative fasting and review the literature. In the presence of LAGB we propose specific anaesthesia management at least consisting of anti-Trendelenburg positioning; avoidance of mask-ventilation; use of the local rapid sequence induction strategy with endotracheal intubation and fully awake extubation.

Update on anesthesia for patients undergoing post-bariatric body contouring surgical procedures

“…It is advisable to empty this chamber prior to induction of anesthesia, use anti-Trendelenburg position, avoid mask-ventilation, and use rapid sequence induction strategy with endotracheal intubation and fully awake extubation. 58 Hypothermia. Hypothermia is a common event in plastic surgery patients due to the long period of time in which they are exposed to the cold environment of the surgical room.…”

Peri-operative management of the obese surgical patient 2015

“…The dilatation may persist following band deflation. There are case reports of regurgitation of food even after prolonged fasting and a tracheal tube is recommended in all patients who have a gastric band . Current advice is not to deflate the band before surgery; however, depending on the extent and type of surgery, a decision to deflate the band may be made on an individual basis.…”

Anesthesia for the surgical procedures of the morbidly obese

“…gastric banding) increase reflux incidence even a long time after treatment and even after weight loss. [22] …”

“…long with plateu pressures of 40-55 cmH 2 O) and relatively lower oxygen values (FiO 2 %0.5-0.8 to prevent atelectasis and oxygen toxicity) as well asnormocarbia-adjusted ventilation values and keeping the patient in the head-up position are recommended. [7,22] As nasogastric tubes and bougies, dilators etc. may be used and repositioned several times during the operation, securing the airway tubes and the follow-up of secretions and bleeding are important.…”