Enhanced Recovery after Surgery (ERAS) in Bariatric Surgery

Preface
Chapter 1
Preoperative Information of  the Patient and Psychological Suitability for Bariatric Surgery
Abstract
Introduction
Background
Psychological and Psychiatric Suitability
Anxiety Disorders
Affective Disorders
Eating Disorders
Substance Use Disorders
Thought Disorders
Personality Disorders
Cognitive Impairment
Psychotropic Medications Use in Bariatric Population
Mental Health Evaluation
Psychological Assessment Tools
Contraindications
Discussion
References
Chapter 2
Preoperative Evaluation in  Bariatric Surgery
Abstract
Introduction
A. Previous Phase to Income
B. Inmediate Preoperative Phase
C. Intraoperative Phase
D. Inmediate Postoperative Phase
E. Postoperative Phase and Discharged
Importance of Preoperative Assessment
Preoperative Assessment
Patient Education
Medical Assessment and Surgical Criteria
Preoperative Analysis Study
1. Analysis Test with High Recommendation and Strong Level of Evidence
2. Analysis Test with Low Recommendation and Weak Level  of Evidence
Metabolic Optimization
Cardiovascular System Assessment
1. Perioperative Cardiac Risk Evaluation
2. Relevant Risk Factors
A. Ischemic Heart Disease
B. Dyslipidemia
C. Arterial Hypertension
D. Venous Stasis with Hypercoagulability
3. Cardiologic Assessment
4. Preoperative Strategies
Respiratory Evaluation
1. More Frequent Respiratory Pathologies Associated to Obesity
A. Obesity Hypoventilation Syndrome (OHS)
B. Obstructive Apnea-Hypopnea Sleep Syndrome (OSAHS)
2. Preoperative Pulmonary Function Testing
A. Chest X-ray
B. Spirometry
C. Polysomnography (PSG)
D. OSAHS Preoperative Assessment Tools
Preoperative Anaesthetic Considerations
1. Preoperative Anaesthetic Study
2. Adjustment of Medications Prior to Hospital Admission
3. Airway Evaluation
4. Premedication
5. Other Issues
A. Difficulty of Venous Access in Obese Patients
B. Venous Thromboembolism (VTE)
Key Points
References
Chapter 3
Relevance of Upper Digestive Endoscopy and Screening  of Helicobacter Pylori in Bariatric Surgery
Abstract
Introduction
Diagnostic Tests for H. pylori
Gastric Pathology Associated  to H. pylori Infection
1. Chronic Gastritis due to H. pylori
2. Gastric Atrophia (GA) and Gastric Intestinal Mertaplasia (GIM) due to Helicobacter Pylori
Relevance of Upper Digestive Endoscopy (UGE)  in Patients Prior to Bariatric Surgery
Relevance of H. pylori Screening in Patients Prior to Bariatric Surgery
References
Chapter 4
Preoperative Nutritional Optimization
Abstract
Introduction
Preoperative Nutritional Evaluation
Preoperative Weight Management
Is There a Role for Preoperative  Carbohydrate Load?
What about Physical Activity?
Is There a Role for Inmunonutrition?
Conclusion
References
Chapter 5
Physical Prehabilitation
Abstract
1. Introduction
1.1. Lifestyle and Morbid Obesity
1.2. Obesity and Physical Activity
1.3. Physical Activity in Bariatric Patients
2. Surgical Complications
2.1. Variables Associated with Surgical Complications
2.1.1. Comorbidities Related to Obesity
2.1.2. Physical Fitness
2.1.2.1. Weight and Body Mass Index
2.1.2.2. Cardiorespiratory Fitness
2.2. Patient’s Recoverys
3. Bariatric Surgery Candidates Profile
3.1. Cardivovasular Risk Factors
3.2. Physical Fitness
3.3. Physical Activity Levels in Patients Awaiting  Bariatric Surgery
4. Assessments in Bariatric Patients
4.1. Assessment of Physical Activity Levels
4.1.1. Objective Measures
4.1.1.1. Accelerometry
4.1.1.2. Pedometers
4.1.2. Subjective Measures
4.1.2.1. Cuestionnaires
4.2. Assessment of Physical Fitness
4.2.1. Body Composition
4.2.2. Cardiorespiratory Fitness
4.2.3. Muscular Strength
5. Exercise before Bariatric Surgery
5.1. Exercise Programs Performed in Patients Awaiting Bariatric Surgery
5.2. Proposed Exercise Guidelines in Patients Awaiting Bariatric Surgery
References
Chapter 6
Immediate Preoperative Assessment
Abstract
Introduction
Preoperative Fasting
A Brief History Review… How did We Reach this Point?
Physiology
Fasting
Insulin Resistance
Dehydration
Gastric Emptying
Particularities of Obese Patient
Recommendations
Ansyolitic Premedication
Actual Guidelines
References
Chapter 7
Antibiotic and Antithrombotic Prophylaxis in Bariatric Surgery
Abstract
Introduction
Antibiotic Prophylaxis
Antibiotic and Dosages
Other Routes of Administration
Antithrombotic Prophylaxis
Primary Prophylaxis
Secondary Prophylaxis: Screening for Asymptomatic Venous Thromboembolism
References
Chapter 8
Intraoperative Anesthetic Measures
Abstract
Introduction
Intraoperative Anesthesic Measures
Tromboprophylaxis
Monitoring
Non-Routine Monitoring
Airway Management
Ventilation Strategies
Neuromuscular Blockade
Key Points
References
Chapter 9
Opioid-Free Anesthesia  and Goal-Directed Fluid Therapy
Abstract
Opioid Free Anesthesia
Intraoperative Management
Multimodal Analgesia
Systemic Medications
Regional Techniques
Conclusions
Goal-Directed Fluid Therapy
Introduction
Definition
Guiding Parameters for Administering Fluids
Intravascular Volume Status Monitorization
GDFT Monitors
GDFT Variables
Conclusions
References
Chapter 10
Intraoperative Surgical Measures
Abstract
1. Introduction
1.1. Anesthesia
1.2. Laparoscopy
1.3. Direct Trocar Entry and Veress Needle Entry  in Laparoscopic Bariatric Surgery
1.4. Nasogastric Intubation
1.5. Intraoperative Leak Testing
1.6. Abdominal Drainage
References
Chapter 11
Early Postoperative Course  in Bariatric Surgery
Abstract
Early Postoperative Diet
Early Ambulation
Analgesia in Bariatric Surgery
Acetaminophen and NSAIDs
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Opioids Analgesics
Multimodal Analgesia
Adjuvants Analgesics
Pregabalin and Gabapentin
Ketamine
Dexmedetomidine
Lidocaine
Sugammadex
Regional Techniques
TAP Blocks
Neuroaxial Techniques
Intraperitoneal Bupivacaine Infusions
Obstructive Sleep Apnea and CPAP
References
Chapter 12
Diet in Bariatric Surgery: Progression and Lifestyle Modification -  A Multidisciplinary Approach
Abstract
Introduction
Phase 0. Pre-Surgical
Phase 1. Protection of Surgery and Detection  of Potential  Complications  (Infections, Bleeding, Suture Dehiscence  and Thrombotic  Complications)
Phase 2. Surgery Protection
Phase 3. Surgery Protection
Phase 4. Surgery Protection
Phase 5. Tolerance
Phase 6. Return to Normality
Annex 1. Weekly Diet Table
Annex 2. Recipe Booklet
References
Chapter 13
Discharge Criteria and Follow-Up
Abstract
Introduction
The Surgical Wound. Surgical Wound Control
Surgical Wound Healing
Closed Surgical Wound Care
Open Surgical Wound Care
Immediate Postoperative and Discharge Criteria
Indications at Discharge [3]
Postoperative Approach Based on ERAS Protocol
Postoperative Follow-Up After Hospital Discharge
Methods
References
Chapter 14
Postoperative Recommendations  of Physical Activity
Abstract
1. Introduction
2. Bariatric Surgery Disadvantages
2.1. Short-Term Disadvantages
Fat Free Mass Loss
Bone Mineral Density Reduction
Suboptimal Weight Loss
2.2. Medium and Long-Term Disadvantages
Weight Regain
3. Pysical Activity and Exercise in  Bariatric Patients
3.1. Benefits of Physical Activity and Exercise
3.2. Levels of Physical Activity in Patients Undergoing Bariatric Surgery
3.3. Exercise Programmes in Bariatric Patients
3.3.1. Short-Term Exercise Programmes after Bariatric Surgery
Effects on Body Composition
Effects on the Bone Health
Effects on Quality of Life
Effects on Cardiovascular Risk Factors
3.3.2. Medium and Long-Term Exercise Programmes after Bariatric Surgery
3.4. Guidelines and Recommendations for Exercise after Bariatric Surgery
Short-Term Exercise Guidelines and Recommendations
Medium and Long-Term Exercise Guidelines and Recommendations
References
Chapter 15
Implementation of ERAS Protocols  in Bariatric Surgery
Abstract
Introduction
ERAS Protocol in Bariatric Surgery
Results of the Implementation of ERAS Protocol in Bariatric Surgery
Results of the Implementation of the Spanish ERAS Protocol in Bariatric Surgery
References
Chapter 16
Economic Aspects  of ERAS Protocols Implementation
Abstract
Introduction
Area 1: Colorectal Surgery
Area 2: Hepatobiliary Surgery
Area 3: Urological Surgery
Area 4: Gynecological Surgery
Area 5: Cardiovascular Surgery
Discussion on the Impact of the Implementation  of Eras Protocols
Conclusion
References
About the Editor
Index