Bariatric Times

MAY 2018

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

Issue link: https://bariatrictimes.epubxp.com/i/975129

Contents of this Issue

Navigation

Page 0 of 28

C l i n i c a l D e v e l o p m e n t s a n d M e t a b o l i c I n s i g h t s i n To t a l B a r i a t r i c P a t i e n t C a r e Volume 15, Number 5 May 2018 A P e e r - R e v i e w e d P u b l i c a t i o n Follow us. Inside EDITORIAL MESSAGES ................. 3 A Message from Dr. John M. Morton: News and Notes on the Latest Issue of BT A Message from Dr. Christopher Still: Where Can You Find "Me"? OPINION REVIEW ........................ 8 Patients with Obesity Need Not Routinely Undergo Rapid Sequence Anesthetic Induction SURVEY RESULTS ..................... 11 Composition and Salaries of the Integrated Health Professional Team in Metabolic and Bariatric Surgery: Results of an ASMBS Survey NEWS AND TRENDS .................. 12 MEETING SYNOPSIS ................. 14 OMA Spring 2018 Summary SYMPOSIUM PREVIEW ............. 17 IFSO 2018 Preview ASMBS FOUNDATION NEWS AND UPDATE .................................... 20 Q&A with ASMBS Foundation President Dr. Rami Lutfi JOURNAL WATCH ...................... 21 REVIEW COURSE LECTURE ....... 22 Predicting and Managing MODA: the Morbid Obesity Difficult Airway WALTER PORIES CARTOON ....... 25 CALENDAR OF EVENTS ............. 25 ADVERTISER INDEX .................. 25 SOARD TOC ............................... 26 OPINION REVIEW Patients with Obesity Need Not Routinely Undergo Rapid Sequence Anesthetic Induction by JAY B. BRODSKY, MD INTRODUCTION A "rapid sequence induction" (RSI) is a technique used by anesthesiologists to produce the rapid onset of general anesthesia and paralysis immediately prior to tracheal intubation in order to reduce the risk of pulmonary aspiration. The goal of RSI is to minimize the time between apnea with loss of protective airway reflexes and successful placement of a cuffed endotracheal tube. RSI consists of the intravenous administration in rapid succession of both a quick-onset anesthetic induction agent and a fast-acting muscle relaxant. Cricoid pressure is applied, and bag-mask ventilation is avoided. Many anesthesiologists continue to perform RSI as part of their routine management of all patients with obesity. There is increasing evidence that this practice is not only unnecessary but might actually be harmful. RSI is usually used before emergency procedures on non- fasted patients and for elective surgical patients who are believed to be at increased risk for pulmonary aspiration. Page 8 Download the BT app for your mobile device! iTunes Google (Android) Scan this QR code with your QR reader for the digital edition of Bariatric Times. Page 22 Presorted Standard U.S. Postage PAID Lebanon Junction, KY Permit #344 Predicting and Managing MODA: the Morbid Obesity Difficult Airway INTRODUCTION In the general population, morbid obesity (MO) has been frequently identified as a risk factor for challenges in airway management. 1–3 The increasing prevalence of obesity globally, coupled with the widespread use of weight loss (bariatric) surgery as a treatment option, has given investigators the opportunity to study large cohorts of patients with MO undergoing elective surgery. 4–7 These and other studies have begun to identify clinical features related to MO that would more accurately predict difficult airways (DA) and develop appropriate management strategies. In this review, we use our previously described schema of '7Ps' Predicting (difficulty), Planning, Positioning and Preoxygenating (the patient), Preparing (equipment), Pharmacology (appropriate choice) and Postoperative (care). While the circumstances and needs of airway management will vary widely depending on the patient, practitioner, and procedure, this review focuses mainly on tracheal intubation as the primary goal of airway management of patients with MO. It is well known that although BMI is a useful screening tool for obesity, among patients with MO, its use alone cannot predict DA. 8–12 Clearly, other MO-related factors should be sought. REVIEW COURSE LECTURE by NAVEEN EIPE, MD

Articles in this issue

Links on this page

Archives of this issue

view archives of Bariatric Times - MAY 2018