Perioperative complications and Intensive Care Unit utilization in super-superobese patients undergoing laparoscopic bariatric surgery

OBJECTIVE: Anesthetic management for super-superobese (SSO) patients (body mass index [BMI] ≥60 kg/m(2)) presents a challenge for anesthesiologists. This study aimed at characterizing the early complications and Intensive Care Unit (ICU) utilization in SSO patients receiving laparoscopic bariatric surgery. MATERIALS AND METHODS: Totally, 25 SSO patients receiving laparoscopic bariatric surgery between June 2006 and December 2011 were reviewed. The data collected included patient demographics, preoperative comorbidities, anesthetic techniques, airway management, perioperative adverse events, ICU utilization, and early complications occurring within 30 days of index surgery. Early complications were defined as the adverse events that led to permanent detrimental effects or required significant additional intervention. RESULTS: A retrospective analysis was performed on data from 25 consecutive SSO patients (age: 31.2 ± 11.1 years; BMI: 64.9 ± 4.7 kg/m(2)). Tracheal intubation was attempted successfully in all patients but was difficult in two cases when using laryngoscopy. Bronchospasm was observed in five cases (20%) after tracheal intubation. Postoperative ICU utilization was required in five cases (20%). Early complications occurred in two cases during their stay in postanesthesia care unit (including one case of respiratory failure and one case of hyperkalemia) and in two cases during their stay in ICU (both with respiratory failure). The incidence of early complications was 16%. All patients were discharged from the hospital without sequelae. CONCLUSIONS: It is imperative to anticipate the potential for developing perioperative adverse events and postoperative complications in SSO patients after bariatric surgery. Appropriate utilization of ICU resources may enhance patient safety.