Outpatient Bariatric Surgery? More Things to Consider than Just Anesthesia Concerns

Dear Bariatric Times friends and colleagues:

I am sure that all readers who attended the 28th annual meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) in Orlando, Florida last month would agree that it was an excellent meeting. I enjoyed it despite the fact that I hate Orlando!

This was a golden brochure for Dr. Bruce Wolf, who had an outstanding year as ASMBS president, and a job well done by ASMBS Program Committee Chair Dr. Marc Bessler and Co-Chair Dr. Nihn Nguyen. I very much enjoyed the session “Review of the best papers of the year,” and thought it was a great idea and addition to the meeting.

I would like to congratulate Dr. Jaime Ponce, who has been named ASMBS President-Elect, and I recommend that everyone tighten their seatbelts and get ready for action as Dr. Robin Blackstone takes the wheel as ASMBS President for the 2011/2012 term. I am sure we will all be touched in some way by Robin’s energy and forward thinking as the Society’s new leader.

In this issue of Bariatric Times, we present two articles that reflect the importance of meticulous care in patients with obesity, not only in the operating room while performing a procedure, but also before and after the surgery. In “Anesthetic Concerns for Performing Bariatric Surgery in a Free-standing Ambulatory Center,” Drs. Brodsky and Ingrande review anesthetic considerations for the surgeon operating on outpatients with morbid obesity, such as the presence of obstructive sleep apnea (OSA), obesity hypoventilation, and airway and anesthesia management.

I can personally relate to the topic of anesthesia, as I recently had to do an emergency tracheotomy on a Sunday afternoon case because the anesthesiologist on call disregarded a clinical history of difficult intubation and lost the airway at induction. Additionally, I had two emergency intubations the evening after surgery due to respiratory arrests in patients with OSA that were disregarded by staff. My personal opinion on ambulatory bariatric surgery is that it is a dangerous way to save money. Not only are type and length of the procedure performed important to consider in patients recovering from anesthesia, but the myriad of comorbid conditions with which patients with obesity present that can create life-threatening situations after general anesthesia should be considered as well. I always tell my fellows, “We operate on healthy tissues but very sick patients.”

I welcome the establishment of the International Society for the Perioperative Care of the Obese Patient (ISOCOP) and recommend that you read this month’s Society Spotlight, which gives an overview of this newly revived group and their mission to help solve common problems facing any anesthesia, or nonanesthesia, provider who cares for patients with obesity.

In this issue, we also present an article by Dr. Steele et al elucidating the role of the hypothalamus, dopamine, and dopaminergic receptors in the development of obesity. I found this article fascinating. Despite this evidence, let us not forget that phenotype plays a major role as well. Our ancestors did not have a refrigerator in their caves to store food and eat three or four times a day and they did not have food available on a daily basis either. Our stomachs are far too big for the quantity and quality of food available to us in the 21st century, and our sedentary lifestyles make it even worse. Think about how little the Chilean miners had to eat on a daily basis and yet they all survived for so long underground. Bariatric patients sometimes say to me, “I never thought we needed so little to function.”

Finally, we present the second installment of “Total Bariatric Care,” authored by Dr. Eric DeMaria. This month he explores the topic of surgery for patient with low body mass index (BMI). I would like to thank Dr. DeMaria for his always-clear prospective on any bariatric topic on which he is asked to comment. The group of patients with BMIs between 30 to 35kg/mg2 is probably the most important topic to discuss in bariatric surgery. While the United States Food and Drug Administration (FDA) approves adjustable gastric banding for the treatment of obesity in this BMI category, the National Institutes of Health (NIH), which continues to neglect the most prevalent disease in America and has not updated guidelines since 1991, does not support surgical treatment in this BMI category, and the Centers for Medicare and Medicaid Services (CMS) probably do not even know what we are talking about. So much for what to do with this patient population…

Lastly, I want to remind everyone planning to attend the ASMBS Fall Meeting, September 23 to 25, 2011, in Chicago, Illinois, to book your hotels. What a great city and time of the year for a conference.

I hope you enjoy reading this month’s issue of Bariatric Times.

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

Tags: Dr. Raul Rosenthal

Category: Editorial Message, Past Articles