30 January 2024 : Case report
[In Press] Successful Anesthetic Management for Obese Patients with Interstitial Lung Disease Undergoing Laparoscopic Sleeve Gastrectomy: A Bridge to Improved Lung Transplant Eligibility
Unusual setting of medical care, Rare diseasePiotr Mieszczański1ABDEF, Marek Janiak 1DE, Paweł Ziemiański 2BE, Radosław Cylke2BDE, Wojciech Lisik 2BEF, Janusz Trzebicki 1ACE
Am J Case Rep In Press; DOI: 10.12659/AJCR.942736
Available online: 2024-01-30, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Patients with obesity with interstitial lung diseases (ILD) are encouraged to lose weight, as it improves lung function and lung transplant eligibility. As exercise tolerance in these patients is low and weight gain is a common adverse effect of corticosteroids, bariatric surgery can be an effective method for the management of obesity in this patient group. However, perioperative complications in such high-risk patients remain a concern. Therefore, we aimed to demonstrate successful anesthetic management for obese patients with ILD, which may be practically utilized to reduce perioperative pulmonary complications and improve outcomes.
Our case report presents a 42-year-old man with ILD who underwent laparoscopic sleeve gastrectomy (LSG). Preoperative studies revealed severe restrictive disease, right ventricular overload with assessed intermediate risk of pulmonary hypertension, and heart failure, with preserved left ventricle fraction but with poor exercise tolerance. Patient had opioid-free anesthesia (OFA) and postoperative multimodal analgesia. Following a 24-h stay in the Post-Anesthesia Care Unit, the patient was transferred to the ward and ultimately discharged home 2 days thereafter. At the 1-year follow-up, the patient reduced his weight by 40 kg and reported a significant improvement in physical capacity.
Our record demonstrates that OFA can be successfully used in high-risk patients with ILD undergoing LSG. In a period of a year, the patient improved so much that he no longer required lung transplantation, which may encourage clinicians to provide bariatric surgery using the OFA technique in the population of patients with obesity and severe respiratory illness.
Keywords: Obesity; Bariatric Surgery; Anesthesia and Analgesia; Idiopathic Pulmonary Fibrosis; Lung Transplantation
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