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Gas Cookbook | Sleeve Gastrectomy

Sleeve Gastrectomy

Pre-op Induction Intra-op Manipulation of Orogastric tube Post-op

Sleeve Gastrectomy

General AnaesthesiaDuration1 - 2 hoursUpdatedJun 2026

Pre-op Induction Intra-op Manipulation of Orogastric tube Post-op

Drug dose adjustment for Bariatric Patients SOBA Calculator
Obesity Surgery Mortality Risk Score MDCalc
STOP-Bang MDCalc
Involves MDT management with optimisation of comorbidities

Pre-Induction

aprepitant80mg
Consider high-flow nasal cannulae during pre-oxygenation
Pre-oxygenation in ramped position
BIS monitoring

Drugs (TCI)

remifentanilTCI
propofolTCI
rocuronium0.6mg/kg

Intubation

Videolaryngoscopy
AirwayETT

Post-Induction

ProcedureOrogastric Tube Insertion36Fr

Maintenance

propofolTCI
remifentanilTCI

Analgesia

morphine0.1mg/kg or fentanyl2-3mcg/kg
magnesium sulphate2.5g
paracetamol1g
diclofenac75mg or

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

For reference only. Always check doses against the BNF and your local protocols, and adapt to the patient in front of you. Gas Cookbook is community-shared guidance, not medical advice; clinical responsibility stays with you.

Technique

IV Induction TIVA

Position OG tube within oesophagus

parecoxib

40mg

Local anaesthetic infiltration by surgical team (Subcostal block)

Anti-emetics

ondansetron4mg
dexamethasone6.6mg

Other

Antibiotics as per local protocol

ondansetron

4mg, 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