Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice > Chapter 55. Anesthesia for Gastrointestinal Surgery Martin Slodzinski, MD, PhD, and William T. Merritt, MD, MBA

Bariatric Procedures

"Ten percent of all health costs in the United States are related to treating obesity and obesity-related complications.²³² Perioperative care of the extremely obese (body mass index [BMI] >40 kg/m²) presents multiple challenges. A myriad of comorbidities including obstructive sleep apnea, diabetes, dyslipidemia, hypertension, atherosclerosis, cardiomyopathy, colicystitis, nonalcoholic steatohepatitis, and certain cancers²³³ make this a formidable group of patients.Although the treatment of acute pancreatitis is primarily medical, surgery may be required for such conditions as draining an abscess. Emerging evidence suggests that early surgery may not be as high a risk as previously thought.²⁴⁹ Patients with pancreatitis are extremely ill with severe abdominal pain and may have fever, nausea and vomiting, jaundice, hypotension, ileus, and external distortion of the stomach on radiographs. Management includes nasogastric suction, maintenance of intravascular volume, anticipation of respiratory insufficiency,^250–252 analgesia, and nutritional support...."