Atelectasis in Bariatric Surgery: Review Analysis and Key Practical Recommendations

Pain Assessment and Analgesic Requirements after Sleeve Gastrectomy: A Comparison Study of Robotic versus Laparoscopic Approaches

Background: Sleeve gastrectomy is the most common bariatric procedure worldwide, yet postoperative pain management remains a concern. This study aimed to compare pain medication usage and pain scores between laparoscopic sleeve gastrectomy (LSG) and robotic sleeve gastrectomy (RSG) patients, addressing the potential benefits of RSG in postoperative pain control. Methods: A retrospective review of our institutional bariatric surgery registry included 484 patients (435 LSG, 49 RSG) who underwent surgery between September 2015 and November 2020. Pain management medications, including opioid use converted to morphine milligram equivalents (MMEs), and Numerical Rating Scale (NRS) scores were analyzed postoperatively using mixed-effects models. Results: RSG patients reported lower pain scores in the initial 24 h post-surgery and received significantly lower doses of morphine equivalents compared to LSG patients (median 7.5 mg vs. 12.5 mg, p < 0.001). RSG procedures had longer operative times (122.5 ± 27.1 vs. 89.9 ± 30.5 min, p < 0.001) but a shorter average length of stay (2.24 ± 0.60 vs. 2.65 ± 1.49 days) compared to LSG. Conclusions: These findings suggest that RSG may lead to reduced immediate postoperative pain and lower opioid requirements compared to the laparoscopic approach, despite longer operative times. Further randomized controlled trials are needed to confirm these observations and evaluate long-term outcomes.

Residual Neuromuscular Block Remains a Safety Concern for Perioperative Healthcare Professionals: A Comprehensive Review

Residual neuromuscular block (RNMB) remains a significant safety concern for patients throughout the perioperative period and is still widely under-recognized by perioperative healthcare professionals. Current literature suggests an association between RNMB and an increased risk of postoperative pulmonary complications, a prolonged length of stay in the post anesthesia care unit (PACU), and decreased patient satisfaction. The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade provide guidance for the use of quantitative neuromuscular monitoring coupled with neuromuscular reversal to recognize and reduce the incidence of RNMB. Using sugammadex for the reversal of neuromuscular block as well as quantitative neuromuscular monitoring to quantify the degree of neuromuscular block may significantly reduce the risk of RNMB among patients undergoing general anesthesia. Studies are forthcoming to investigate how using neuromuscular blocking agent reversal with quantitative monitoring of the neuromuscular block may further improve perioperative patient safety.

An Unusual Case of Severe Atelectasis: Mucus Impaction in a Young Obese Female

Atelectasis is defined as the the loss of lung volume due to collapse of lung tissue and is usually associated with symptoms of respiratory distress, including increased work of breathing and increased oxygen requirements. It is common in hospitalized patients with limited mobility and in patients with underlying lung conditions. Treatment is largely supportive when no underlying condition is identified. It is rare to occur in otherwise healthy individuals. The patient in this case presented to the emergency department with complaints of progressive shortness of breath, productive cough, chest tightness, subjective fever, chills, and nasal congestion for two weeks. Physical exam revealed decreased breath sounds on the left side, raising the suspicion for atelectasis or pneumothorax. Chest X-ray revealed complete white-out of the left lung. Bronchoscopy was performed and revealed mucus impaction in the left mainstem bronchus, which was removed. Repeat chest X-ray revealed resolution of atelectasis. The patient's symptoms improved, and she was discharged with outpatient pulmonary follow-up. The case described below illustrates that even in young patients with no underlying comorbidities, other than obesity, atelectasis as a cause of respiratory complaints should always be considered.