Anesthesia and Enhanced Recovery After Surgery in Bariatric Surgery

Abstract

The Enhanced Recovery After Surgery Society published guidelines for bariatric surgery reviewing the evidence and providing specific care recommendations. These guidelines emphasize preoperative nutrition, multimodal analgesia, postoperative nausea and vomiting prophylaxis, anesthetic technique, nutrition, and mobilization. Several studies have since evaluated these pathways, showing them to be safe and effective at decreasing hospital length of stay and postoperative nausea and vomiting. This article emphasizes anesthetic management in the perioperative period and outlines future directions, including the application of Enhanced Recovery After Surgery principles in patients with extreme obesity, diabetes, and metabolic disease and standardization of the pathways to decrease heterogeneity.

Keywords: Bariatric surgery; ERAS; Enhanced recovery; Fluid management; Multimodal analgesia; Postoperative nausea and vomiting (PONV) prophylaxis; Prehabilitation; Preoperative fasting.