Current updates and anesthetic considerations for adolescent metabolic and bariatric surgery

Pediatric obesity has grown in prevalence over the last several decades and is a major public health crisis. Early intervention is favored to prevent obesity related co-morbidities. Metabolic and bariatric surgery (MBS) in the pediatric population has increased in frequency and is shown to be safe and effective as part of a multifaceted and multidisciplinary approach to weight loss. However, surgical management currently remains an underutilized option compared to the significant number of patients who meet current eligibility criteria. Most adolescent MBS procedures are performed on patients greater than 16 years of age. Anesthetic management of pediatric bariatric patients should include a thorough preoperative evaluation, with attention to obesity related co-morbidities and home medications. Intraoperative management and postoperative planning should include consideration of obesity-related potential complications. Development and implementation of ERAS pathways for pediatric MBS can mirror the success of adult MBS outcomes due to the synergy of multidisciplinary management of this complex patient population.