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noteslapgb

Laparoscopic gastric banding


Laparoscopic gastric binding:

• Pre-operative interview:
– Age, residence, cardiovascular disease, lung disease, OSA, GERD, DM, smoking hx
– Facial hair, height, weight, BMI, previous surgeries, drug allergies, family history
– PONV, hypertension, neck motility, digital pictures
• Pre-operative medications on the day of surgery:
– Scopolamine patch behind ear
– Pepcid 20 mg and Reglan 10 mg IV
– Bicitra 30 ml po
• Pre-operative considerations:
– Troop elevation pillow, chin higher that chest
– Inflatable transfer mattress
– Extremity padding
– Fresh soda lime
– Modest reverse Trendelenburg
– Versed 2-3 mg and fentanyl 75-100 mcg (to lessen sympathetic response)
– Defasciculation with rocuronium 5 – 7 mg
– Vigorous preoxygenation
– Neuromuscular block monitor on
– Cefazolin 1 gram IV
– Difficult airway equipment – bougee, light wand, ILMA, Levitan, blades, etc.
• Induction:
– Propofol and succinylcholine
– Cricoid pressure
– Twitch diminution
– Secure airway
– Surgeon nearby for tracheotomy if needed
• Maintenance of anesthesia:
– Lidocaine or labetalol prn
– Rocuronium 30 mg
– Desflurane (sevoflurane 2nd choice)
– Mechanical ventilation @ 10 ml/kg and 5-10 ml of water PEEP
– Zofran, Phenergan, Decadron IV
– Placement of gastric tube
– Suction of stomach, esophagus, and pharynx as gastric tube is pulled
– Ketorolac 60 mg IV as case ends
• Emergence:
– Propofol or lidocaine to smooth wakeup
– Full reversal of NMBA’s in all patients
– Following commands at extubation
– Semi-upright positioning during transport


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