Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases

Background: Bariatric surgery for morbid obesity implies challenges in anaesthesiological handling. We report our experience from 500 consecutive patients during 3 years. Methods: The patients were due for laparoscopic Roux-en-Y gastric bypass and enteral bypass. Sleep was induced after pre-oxygenation with target control infusions (TCI) of remifentanil and propofol; vecuronium was supplied for facilitating endotracheal intubation. The propofol infusion was stopped and desflurane 3-6% was given for BIS-titrated anaesthetic maintenance together with remifentanil TCI. Antiemetic prophylaxis was supplied with intravenous (IV) droperidol, ondansetron and dexamethasone; post-operative pain prophylaxis was IV paracetamol, parecoxib and bupivacaine infiltration. The patients were extubated in the operating room and kept in the post-operative care unit for 3-4 h, being tested for a 20 m walk before discharge to the ward. Results: The procedure was uncomplicated peri-operatively in all 500 cases and in 497 patients (99.4%) post-operatively. Three patients had one complication, which resolved without sequelae: oesophageal rupture from gastric tubing, reoperation for anastomosis leakage and pneumonia. The mean duration of surgery was 57 min (range 37-91). The mean time from the start of anaesthesia until the start of surgery and time from the end of surgery until the end of anaesthesia were both significantly reduced throughout the study period, from 23 to 7.8 and 5.8 to 1.9 min, respectively (P < 0.001). The mean total hospital stay was reduced from 3 days at start to 2 days in the end of the series (P < 0.05). Conclusion: Safe bariatric short-stay surgery is feasible with a dedicated anaesthesiological concept in an expert surgical team.