Enhanced Recovery after Surgery (ERAS) in Bariatric Surgery

Contents
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
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