Individuals who have undergone bariatric surgery and have lost a considerable amount of weight tend to seek consultation with plastic surgeons for body contouring surgery. This growing population is overweight, and they still have some of the co-morbidities of obesity, such as hypertension, ischemic heart disease, pulmonary hypertension, sleep apnea, iron deficiency anemia, hyperglycemia, among other pathologies. They should be considered as high anesthetic risk and therefore, should be thoroughly evaluated. If more than one surgery is planned, a safe operative plan must be defined. The anesthetic management is adjusted to the physical condition of the patient, the anatomical and physiological changes, the psychological condition, as well as the surgical plan. Anemia is a frequent complication of obesity and bariatric procedures and should be compensated with appropriate anticipation. Pre-anesthetic medications may include benzodiazepines, alpha-2 agonists, anti-emetics, antibiotics, and pre-emptive analgesics. Regional anesthesia should be used whenever possible, especially subarachnoid blockade, since it has few side effects. General anesthesia should be left as the last option and can be combined with regional techniques. It is prudent to use conscious sedation for facial and neck surgery, maintaining strict control, especially with respect to the airway management. Thromboprophylaxis is mandatory and should continue for several days after the operation.

The fascinating history of local anesthetics (LAs) began in South America with the herbal and traditional use of cocaine leaves by the indigenous peoples of Peru and Bolivia, the sacred plant of the Incas Erythroxylum coca. The use for anesthetic purposes dates back to 1884. Since then, the evolution of LAs has been closely related to research motivated by its efficacy and safety versus toxicity. According to their chemical structure, these drugs are classified into two main groups: esters and amino amides; however, there are three LAs with different characteristics: articaine, sameridine, and centbucridine. The pharmacological and toxic mode of action is primarily in the voltage-dependent sodium channels located in the cell membrane, which clinically produces analgesia, anesthesia, seizures, arrhythmias, and cardiac arrest. The quality of anesthesia and analgesia depends on the type of LA, dose, and application technique, while the deleterious effects are secondary to its plasma concentration. Nonanesthetic properties of LAs such as their antimicrobial, antineoplastic, antiarrhythmics, antitussive, and antiasthmatics effects have been described and are briefly reviewed.