Presented by Emma Patterson of Oregon Weight Loss Surgery at the 2024 ASMBS Conference
Emma J. Patterson, MD, FACS, FRCSC, FASMBS, a renowned expert in bariatric surgery, recently delivered an insightful lecture on “Sleeves in ASC: How I Do It and Clinical Protocols” at the 40th Annual ASMBS Conference in San Diego. The presentation provided an in-depth look at her meticulous protocols and strategies for performing sleeve gastrectomy in an ambulatory surgical center (ASC) setting. Her lecture highlighted the essential elements of preoperative preparation, intraoperative techniques, and postoperative care, ensuring a safe and effective patient experience.
The Team Approach and Anesthesia Protocols
Dr. Patterson emphasized the importance of a collaborative team approach at the Wilshire Surgery Center, showcasing a picture of the dedicated team including prep and PACU nurses and anesthesia specialists. This cohesive team effort is critical for managing the unique challenges of outpatient surgery, particularly in the context of sleeve gastrectomy.
Preoperative Protocols
Patient Education and Preparation:
Expectation Management: Dr. Patterson stressed the significance of setting realistic expectations through comprehensive patient education covering the preoperative, day-of-surgery, and postoperative phases.
Preoperative Visit: This includes a liquid diet regimen, administration of vitamins (MVI, thiamine, biotin), skin preparation, individual venous thromboembolism (VTE) assessment, and prescriptions for pain management, nausea, and proton pump inhibitors (PPI).
Thromboembolism Prevention:
Dr. Patterson discussed the balance between clotting and bleeding risks, utilizing the Modified Caprini Score for VTE assessment and battery-operated sequential compression devices (SCDs) to mitigate risks.
Intraoperative Protocols
Induction and Intubation:
The lecture outlined the detailed induction process, including the administration of large doses of propofol and the use of rocuronium or vecuronium for muscle relaxation. A wedge or blanket ramp is used for optimal intubation positioning, assisted by a Glidescope or McGrath for endotracheal tube (ETT) placement.
Anesthesia and Bleeding Control:
Anesthesia maintenance with sevoflurane, propofol infusion, and controlled fentanyl administration ensures patient stability. To prevent and manage bleeding, Dr. Patterson recommended blood pressure control, staple line buttressing, and the use of surgical powders or fibrin sealants.
Postoperative Protocols
Immediate Postoperative Care:
Postoperatively, patients receive additional doses of antibiotics, acetaminophen, and, if necessary, oxycodone or morphine for pain management. Early mobilization and incentive spirometry are encouraged to promote recovery and prevent complications.
Discharge and Follow-Up:
Upon discharge, patients are prescribed a regimen of ibuprofen and acetaminophen, along with a specific dietary plan of full liquids and gradual introduction of protein and calories. Continuous ambulation, hourly incentive spirometry, and timely follow-up calls from registered nurses ensure ongoing patient support.
Dr. Patterson’s lecture on sleeve gastrectomy in an ASC setting encapsulated her thorough and patient-centric approach. By adhering to rigorous preoperative, intraoperative, and postoperative protocols, she ensures optimal outcomes and patient safety. Her detailed protocols serve as a valuable guide for other practitioners aiming to excel in the field of bariatric surgery within an ambulatory surgical center environment.
As the most experienced weight loss surgery program in the Northwest, the metabolic and bariatric surgery team at Oregon Weight Loss Surgery is ready to guide you on the path to a happier and healthier future!
Dr. Patterson, Dr. July and their specialized staff are dedicated to providing you with a compassionate, supportive, and effective bariatric surgery journey.
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