Anesthesia protocol for bariatric surgery: A quality improvement process

Objective: The purpose of this quality improvement process was to review current enhanced recovery after surgery (ERAS) protocols for bariatric surgeries, analyze the current anesthesia protocol used at a midwestern medical center, and propose potential system modifications for best practice in the bariatric surgical population.Methods: All articles published between 2009 and March 2019 that contained specific keywords were critically appraised or discarded. Additional articles were discovered through cross references from previously found articles.Major points: The midwestern medical center protocol reviewed followed ERAS guidelines closely. Both parties agreed on the use of antiemetics, multimodal analgesics, positioning, oxygen therapy, and use of a neuromuscular blocking agent followed by reversal. The midwestern medical center was more specific in some areas but all remained within recommendations by ERAS. ERAS guidelines were more complete in recommendations for lung protective strategies and intravenous fluid management.Conclusion: Many of the elements included in the midwestern medical centers protocol, if not already in agreement with ERAS guidelines, was supported by more recently published studies. Recommendations for the midwestern medical center were made as potential system modifications with the intent of minimizing perioperative complications in the bariatric patient population.