The American Society of Anesthesiologists recently issued consensus-based guidance recommending that daily GLP-1 medications be held on the day of procedure and weekly GLP-1 medications be held one week prior to procedure, regardless of whether used for diabetes or obesity.
The 2019 AAP guidelines removed a minimum age limit for bariatric surgery and recommended case-by-case consideration of special populations including those with developmental disability or cognitive impairment, rather than automatic exclusion.
Preoperative Optimization and Management - Caren Mangarelli, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 17 · 2:00
guidelineThe 2019 AAP technical report and policy statement on bariatric surgery established selection criteria that were less conservative than previous guidelines and more aligned with adult criteria.↗
▶Ep 17 · 3:00
guidelinePediatric bariatric surgery candidates include patients with BMI ≥40 or ≥140% of the 95th percentile (whichever is lower), or BMI ≥35 or ≥120% of the 95th percentile (whichever is lower) with a comorbid condition.↗
▶Ep 17 · 4:30
guidelineThe 2019 AAP guidelines removed a minimum age limit for bariatric surgery and recommended case-by-case consideration of special populations including those with developmental disability or cognitive impairment, rather than automatic exclusion.↗
▶Ep 17 · 6:00
guidelineEssential multidisciplinary team members for pediatric bariatric surgery are surgeon, medical specialist, behavioral/mental health specialist, and registered dietitian.↗
▶Ep 17 · 10:00
clinicalSince December 2020, the FDA has approved three new medications for obesity treatment in patients 12 years and older, including two GLP-1 agonists.↗
▶Ep 17 · 11:00
guidelineThe American Society of Anesthesiologists recently issued consensus-based guidance recommending that daily GLP-1 medications be held on the day of procedure and weekly GLP-1 medications be held one week prior to procedure, regardless of whether used for diabetes or obesity.↗
▶Ep 17 · 11:30
clinicalGLP-1 medications work in part by slowing gastric emptying, raising theoretical and practical concerns about regurgitation and pulmonary aspiration of gastric contents perioperatively.↗
▶Ep 17 · 13:00
epidemiologicalIn the Teen-LABS 5-year data, micronutrient deficiencies occurred postoperatively, with iron being the most common deficiency both pre- and postoperatively, and the percentage of patients with deficiencies increased over time.↗
▶Ep 17 · 14:00
clinicalDr. Mangarelli's program has screened preoperatively for iron and vitamin D specifically, but is considering expanding screening after encountering postoperative cases of thiamine (B1) and folate deficiency.↗
▶Ep 17 · 15:30
epidemiologicalIn Dr. Mangarelli's inner-city patient population in a state where marijuana is legal recreationally and medicinally, marijuana use is common among adolescent bariatric surgery candidates.↗
▶Ep 17 · 16:30
opinionSome bariatric programs require complete abstinence from substances before proceeding with surgery, but Dr. Mangarelli's team has adopted a harm reduction approach rather than denying surgery to patients who may need it for medical reasons.↗
▶Ep 17 · 17:30
epidemiologicalShort-term studies (up to 2 years) in adult populations have not shown that bariatric surgery outcomes differ in patients who disclosed marijuana use.↗
▶Ep 17 · 18:00
epidemiologicalTwo current patients in Dr. Mangarelli's program disclosed regular marijuana use for self-medicating anxiety disorders, and anxiety disorders have increased approximately fourfold pre- versus post-COVID.↗
▶Ep 17 · 18:17
epidemiologicalTeen-LABS data show that alcohol use disorder is not uncommon postoperatively in pediatric bariatric surgery patients.↗
▶Ep 17 · 19:33
clinicalAt least one insurer has treated marijuana use similarly to nicotine smoking and requested ABG and pulmonary function tests for bariatric surgery candidates.↗
▶Ep 17 · 19:58
quoteso I understand that I'm not gonna be able to drink as much. And I said, no. She goes, cause currently my tolerance is at about 10 shots.↗
