Outline the key issues in the post-operative management of a super-obese (BMI 59) patient with type 2 diabetes following sleeve gastrectomy.
Answer and interpretation
- Monitoring of vital signs
- SpO2 and ABGs for PCO2
- Use of CPAP post op if required. May use patient’s own CPAP device but issues with leak, need for
oxygen supplementation, etc. may require ICU machine usage
- Monitor electrolytes especially K+, urine output
- Appropriate fluids can be Hartmanns, 5% glucose, dextrose saline all of which will provide an
energy substrate and avoid starvation ketosis
Maintain euglycaemia (BSL 4-10)
- Insulin either as an intravenous infusion or intermittent sub-cut bolus to maintain BSL 4-10. No
evidence even in this group to support tight BSL control
Avoid starvation ketosis
- Post-operative oral fluids or diet should be discussed with surgical team and appropriate diet
commenced as soon as practical
- Adequate analgesia avoiding opioids
- DVT prophylaxis- mechanical prophylaxis for all with low molecular weight heparin if no
- Ensure appropriate posture/positioning in bed to optimize respiratory function and minimize gastro-
oesophageal reflux and for pressure care
- Early mobilization is essential. Goals should be set in conjunction with physiotherapy staff including,
for example, sitting out of bed within 18 hours, walking within the next 24 hours.
- Special bariatric beds required and may also need large chairs so patients can be sat out of bed.
- Hoists etc. / manual handling training for staff
- Test for leak as per surgical protocol e.g. ice water test, gastrograffin swallow.
- Pass rate: 75%
- Highest mark: 8.3
Additional Examiners’ Comments:
- Candidates who scored well mentioned specific challenges and considerations (rather than just generic “ABCs”) and suggested strategies to address these.