Bariatric Anesthesia
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Stanford University Anesthesiology Residency Program
Goals and objectives for residents in bariatric anesthesia rotation
Rotation faculty: Drs. Ingrande, Lemmens, Brodsky
Description
This is a two-week rotation that provides training in the pre-, peri-, and post-operative management of obese and morbidly obese individuals. Residents will be exposed to 5-10 bariatric surgery cases. One resident shall be assigned per rotation. This rotation will be open to all levels of residents.
Assigned readings will come from Morbid Obesity: Perioperative Management, 2nd Edition. Residents will be responsible for discussing the cases with their attending the night before and after the procedure.
Resident attendance at the weekly resident talk as well as Monday AM Grand Rounds is expected. It is also expected that residents spend time outside of clinical work for independent reading.
Feedback via a daily debriefing at the end of the workday is expected. At the end of the rotation, the rotation director with input from other faculty (including input from the bariatric surgeons and surgery residents and OR nurses) will evaluate the resident in all 6 core competencies via MedHub.
Types of Cases
- Restrictive operations
- --vertical banded gastroplasty
- --gastric banding
- --sleeve gastrectomy
- Gastric restriction/Malabsorptive procedures
- --Roux-en-Y gastric bypass
Goals and Objectives
The overall objective of this rotation is to obtain proficiency in the anesthetic management of obese patients. To accomplish this, residents should be able to:
Medical knowledge
• Describe the pathophysiology of obesity and its effects on various organ systems
• Explain the differences between various body weight scalars used to classify body weight
• Discuss the epidemiology of obesity including its incidence and classification
• Translate the anthropometric changes associated with obesity and their effects on anesthetic management including physiologic and pharmacologic implications into construction of the anesthesia plan
• Describe the pathophysiology of Obstructive Sleep Apnea (OSA) and Obesity Hypoventilation Syndrome (OHS) and their effects on anesthetic management
• Describe short gut or blind loop syndrome. What procedures are associated with this problem?
Patient care
• Appropriately evaluate risk factors for a difficult airway in obese patients
• Safely manage the airway in obese subjects
• Describe the pharmacologic management and changes in pharmacokinetics and pharmacodynamics of anesthetic agents unique to obese individuals
• Become comfortable in obtaining intravenous access in these obese and morbidly obese individuals.
• Appropriately position these patients given knowledge of association of patient position on respiratory mechanics, peripheral nerve injury, and rhabdomyolysis
• Effectively oxygenate and ventilate these patients both pre-, peri-, and post-operatively
• Evaluate safety and other concerns associated with opioid administration and post-surgery analgesia
• Identify postoperative problems as their evaluation. What are grounds for re-exploration?
Interpersonal communication skills
• Identify the postoperative concerns in obese subjects via a postoperative visit and note
• With the rest of the OR team evaluate proper positioning requirements of patient prior to incision
• Complete a time-out with OR team
Systems-Based Practice
• Confirm full proper preoperative assessment note in EPIC for every patient
• Interact and participate in hospital initiatives to improve quality and efficiency in the care of obese patients.
• Understand epidemiology and presentation of perioperative thromboembolic disease. Understand system-wide tools and methodology for reducing DVT
• Practice cost-effective healthcare and resource allocation without compromise of patient care
Professionalism
• Properly introduce themselves to patient and obtain informed consent after review risks and benefits of anesthesia
• Facilitate the surgical procedure through timely arrival and preparation, including turnover times less than 30 mins
• Demonstrate sensitivity and responsiveness to patient’s weight
Practiced based learning
• At end of two weeks identify with attending faculty 3 areas that resident needs to improve their own practice
• Perform literature search and read 3 articles related to one specific problem encountered during care of obese patient
