Anesthesia for Morbidly Obese Patients

Abstract

Bariatric surgery is the most effective method for treating patients with morbid obesity, and participation of the anesthesiologist in the treatment of these patients is more and more frequent. Therefore it is important for anesthesiologists to be familiar with anatomic and physiologic implications and the pharmacologic changes associated with obesity, so they can offer optimal perioperative treatment. The present study describes a series of 37 patients with an average body mass index of 50.3 kg/m2 who underwent bariatric surgery in a third-level teaching hospital in Mexico City. Preoperative assessment, airway management, perioperative treatment, and the incidence of complications are analyzed. We found a high frequency of associated diseases, among which diabetes mellitus and systemic arterial hypertension were the most prominent. Cardiorespiratory complications such as obstructive sleep apnea syndrome and obesity-hypoventilation syndrome were particularly frequent (16.2% and 22.0%, respectively). Both general anesthesia and mixed anesthesia (peridural block plus light general anesthesia) were employed. The incidence of complications related to perioperative and anesthetic management was low. We discuss and propose protocols for the evaluation and management of airway and associated cardiorespiratory complications.

Improvement of Associated Respiratory Problems in Morbidly Obese Patients after Open Roux-en-Y Gastric Bypass

“…3,6,7,15 Super-obese patients had respiratory co-morbidity, defined as a breathing dysfunction due to fat accumulation in the respiratory system. 5,16 At 1 year after RYGBP, our patients showed weight in the low range of morbid obesity, consistent with the results of other studies.…”

How to inform a morbidly obese patient on the specific risk to develop postoperative pulmonary complications using evidence-based methodology

“…Consequently, the studies by Ogunnaike and colleagues [11], Flancbaum and colleagues [12] and Dominguez-Cherit and colleagues [13] were excluded from further analysis. The study by Blouw and colleagues [10] was not considered to be a cohort study with acceptable methodology as described above, but its figures were extracted from outcomes researchwork that studies a single cohort of patients with the same diagnosis (obesity) and relates their clinical and health outcomes to the care that they received (abdominal surgery).…”

“…Our patient was a 46-yr-old female with a body mass studies, by using the PubMed function related articles for the seven hits, and by manually searching the reference lists of those studies for cross-references. Altogether we found 14 articles [3][4][5][6][7][8][9][10][11][12][13][14][15][16] eligible for critical appraisal, as depicted in Table 1.…”

A retrospective analysis of airway management in obese patients at a teaching institution

“…Perioperative management of obese patients carries higher risks [1][2][3][4][5][6][7] than it does in non-obese patients. Hazards regarding airway management include rapid desaturation after cessation of spontaneous ventilation due to a decrease in functional residual capacity [8], decreased pulmonary compliance, increased airway resistance, increased oxygen demand [9], possible difficult mask ventilation and laryngoscopy [10], upper airway obstruction due to pharyngeal fat deposits [6,[11][12][13][14][15] and possible aspiration caused by gastroesophageal reflux disease (GERD) [16,17].…”