Sleeve Gastrectomy

Maintenance

• propofolTCI
• remifentanilTCI

Analgesia

• morphine0.1mg/kg or fentanyl2-3mcg/kg
• magnesium sulphate2.5g
• paracetamol1g
• diclofenac75mg or parecoxib40mg
• Local anaesthetic infiltration by surgical team (Subcostal block)

Anti-emetics

• ondansetron4mg
• dexamethasone6.6mg

Other

• Antibiotics as per local protocol

Gastric decompression

• Reduces stomach volume, improves exposure, lowers aspiration risk

Guidance for stapling (sizing the sleeve)

• Pass OG tube along lesser curvature, advanced under direct communication with surgeon
• Acts as stapling guide to ensure uniform gastric sleeve + patency of GI passage

Leak testing

• Abdominal cavity filled with saline solution
• At surgeon's request, oxygen insufflated at 2l/min into gastric pouch, then released
• Surgeon watches laparoscopically for bubbles

Recovery Use

• fentanylIV, 10-20mcg, PRN
• morphineIV, 1-2mg, PRN

Analgesia

• tramadolPO/IV, 50-100mg, QDS PRN
• morphinePO, 5-10mg, QDS PRN
• morphineSC, 5-10mg, QDS PRN
• Paracetamol1g QDS

Anti-emetics

• ondansetron4mg, TDS
• ondansetron4mg, TDS PRN
• cyclizine50mg, TDS PRN
• aprepitant80mg, 48 hourly

Anti-hypertensives

• nifedipineSublingual, 10mg, PRN
• amlodipinePO, 10mg, PRN
• glyceryl trinitrateTransdermal, 1 Patch, PRN

Other

• salbutamolNebulised, 2.5mg, 4 hourly PRN
• methylene bluePO, 3 drops in 60ml water, Blue dye leak test
• simeticonePO, 5ml, TDS
• pantoprazoleIV, 40mg, Once Only
• lansoprazolePO, 30mg OD

VTE Prophylaxis

• enoxaparinSC, 40mg OD, <160kg or enoxaparinSC, 40mg BD, >160kg

Fluids

• Plasma-Lyte 1481,000ml IV over 8 hours x 3