Body Contouring Following Bariatric Surgery And Massive Weight Loss: Post-Bariatric Body Contouring

Anesthesia for Contouring Body in Post-Bariatric Surgery Patient

Author(s): Marwan S. Rizk, Cynthia J. Karam and Chakib M. Ayoub

Pp: 148-166 (19)

DOI: 10.2174/978160805238711201010148

* (Excluding Mailing and Handling)

Abstract

Obesity is a major health problem throughout the world. Its management by bariatric surgical interventions is associated with a good success rate, leading to a necessary removal of excess skin after weight loss. The popularity of bariatric surgery has created this new patient population characterized by major anatomical and physiological changes with Massive Weight Loss (MWL) who still maintains many of the co-morbidities of obesity. As a part of a multidisciplinary management, anesthetic management of these patients should take the specific problems into consideration associated with obesity and optimize them before surgery. All these factors such as physical changes, co-morbid medical conditions (pulmonary, cardiovascular and metabolic changes such as vitamin deficiencies etc.), airway difficulty, propensity for venous thrombosis, embolism, patient positioning, avoidance of hypothermia, pharmacodynamics and pharmacokinetics of anesthetics and changes related to bariatric surgery as well are all addressed in this chapter.

Another important aspect that is addressed is the role of regional anesthesia and its advantages over general anesthesia for these patients, taking into consideration the difficulty in palpating bony landmarks or even identifying the midline because of skin laxity and residual excess adipose tissue and therefore neuroaxial blockade could be challenging.

Finally the postoperative management is optimized by development of clinical pathways involving the surgeon, anesthesiologist, patient and support staff. Although obvious physical and physiological improvement may be attained by such surgical procedures, the patient must be fully informed of the multiple risks and complications inherent in such procedures.


Keywords: Anesthesia in obese patients, body contouring, post massive weight loss surgeries, regional anesthesia and landmarks, physiology in post MWL patients, phramacodynamics in post MWL patients.

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316636918 and j.to_ip >=316636918 )) and ((j.from_date <= 1740472368 and j.to_date >= 1740472368 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 460) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316636918 and j.to_ip >=316636918 )) and ((j.from_date <= 1740472368 and j.to_date >= 1740472368 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 460) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316636918 and j.to_ip >=316636918 )) and ((j.from_date <= 1740472368 and j.to_date >= 1740472368 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 460)
      670μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 822 and `b`.`banner_from_date` <= 1740472368 and `b`.`banner_to_date` >= 1740472368 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.11msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 822
      • 3: 1740472368
      • 4: 1740472368
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='9b52010ea7c61dd8e918ecca6e262d33'
      250μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    6Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        Dln1clTSUMhSsGCGV0YzyExEXiTa8ZAPi29RtrMB
        uc_cart_id
        9b52010ea7c61dd8e918ecca6e262d33
        _previous
        array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/460" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/460
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Tue, 25 Feb 2025 08:32:48 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Im1tWEpOd2oxSi9FYTBSbTJGbVQ5U1E9PSIsInZhbHVlIjoidjZrTngrL2dJYkNJaUNEUnE2dXpoTUFXUkRYa1JKNThUSmpxN3lhM3BzQ3NvK0w0L29rZHl5dkhFeHM4UXI5UmltQzJWamEvMmhBMHhqazlLaW1pQVJEcWw5ZmdJK2pvNjhkbDd2OXhaNW85NUZ3WStmb3BhV2tSQnFFWTl1QW4iLCJtYWMiOiJiOTUyNDRhOWVkNzc3MWNmNjc2YWUwNjEzZmQzODk3MTcyN2RiZDM2MWU4NzlhNjVlMzY0NWYzNDE2ZjcwMDIzIiwidGFnIjoiIn0%3D; expires=Thu, 27 Feb 2025 20:32:48 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6Im1tWEpOd2oxSi9FYTBSbTJGbVQ5U1E9PSIsInZhbHVlIjoidjZrTngrL2dJYkNJaUNEUnE2dXpoTUFXUkRYa1JKNThUSmpxN3lhM3BzQ3NvK0w0L29rZHl5dkhFeHM4UXI5UmltQzJWa" 1 => "alphaeurekaselectnet_session=eyJpdiI6IjUxN1ZmTDdyK0VVWE5RSWtjMXRlL0E9PSIsInZhbHVlIjoieDVaMTNsWklVcy9pSjR1aVhvckpXRW9zTUhEY3UvSklxZjlhODgwd1BPWURjSWZkbmNwVm9jbWJ5SmYrdCtWM1UvcC9nMVBBQVllSmY2Z3JkdkpCME9UeTB2b3p1MGRTK1VhL3R3WXBYTVcxMndkRjBJUWFFbEdiZFpadDhNL2kiLCJtYWMiOiIzMzkzMmU0YzIyNGExYzZhYTA0NGI1Y2JmYjNlMTkxZDM5NDVmNjQyYzQzZjNkZGRiNGRmM2M2OWY0ZTg2ZDFkIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IjUxN1ZmTDdyK0VVWE5RSWtjMXRlL0E9PSIsInZhbHVlIjoieDVaMTNsWklVcy9pSjR1aVhvckpXRW9zTUhEY3UvSklxZjlhODgwd1BPWURjSWZkbmNwVm9jbWJ" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Im1tWEpOd2oxSi9FYTBSbTJGbVQ5U1E9PSIsInZhbHVlIjoidjZrTngrL2dJYkNJaUNEUnE2dXpoTUFXUkRYa1JKNThUSmpxN3lhM3BzQ3NvK0w0L29rZHl5dkhFeHM4UXI5UmltQzJWamEvMmhBMHhqazlLaW1pQVJEcWw5ZmdJK2pvNjhkbDd2OXhaNW85NUZ3WStmb3BhV2tSQnFFWTl1QW4iLCJtYWMiOiJiOTUyNDRhOWVkNzc3MWNmNjc2YWUwNjEzZmQzODk3MTcyN2RiZDM2MWU4NzlhNjVlMzY0NWYzNDE2ZjcwMDIzIiwidGFnIjoiIn0%3D; expires=Thu, 27-Feb-2025 20:32:48 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6Im1tWEpOd2oxSi9FYTBSbTJGbVQ5U1E9PSIsInZhbHVlIjoidjZrTngrL2dJYkNJaUNEUnE2dXpoTUFXUkRYa1JKNThUSmpxN3lhM3BzQ3NvK0w0L29rZHl5dkhFeHM4UXI5UmltQzJWa" 1 => "alphaeurekaselectnet_session=eyJpdiI6IjUxN1ZmTDdyK0VVWE5RSWtjMXRlL0E9PSIsInZhbHVlIjoieDVaMTNsWklVcy9pSjR1aVhvckpXRW9zTUhEY3UvSklxZjlhODgwd1BPWURjSWZkbmNwVm9jbWJ5SmYrdCtWM1UvcC9nMVBBQVllSmY2Z3JkdkpCME9UeTB2b3p1MGRTK1VhL3R3WXBYTVcxMndkRjBJUWFFbEdiZFpadDhNL2kiLCJtYWMiOiIzMzkzMmU0YzIyNGExYzZhYTA0NGI1Y2JmYjNlMTkxZDM5NDVmNjQyYzQzZjNkZGRiNGRmM2M2OWY0ZTg2ZDFkIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IjUxN1ZmTDdyK0VVWE5RSWtjMXRlL0E9PSIsInZhbHVlIjoieDVaMTNsWklVcy9pSjR1aVhvckpXRW9zTUhEY3UvSklxZjlhODgwd1BPWURjSWZkbmNwVm9jbWJ" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "Dln1clTSUMhSsGCGV0YzyExEXiTa8ZAPi29RtrMB" "uc_cart_id" => "9b52010ea7c61dd8e918ecca6e262d33" "_previous" => array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/460" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-25 08:32:48GET/chapter/460112198