Ambulatory anesthesia for the obese patient.
OBJECTIVE
Obese patients are more and more frequently proposed for elective surgery, including acts specifically aimed at curing this condition, i.e. bariatric surgery. Many of these acts present characteristics compatible with ambulatory treatment, but anesthesiologists are reluctant to treat the morbidly obese as outpatients due to lack of data on the safety of this approach. The purpose of this review is to present the information that could be found in the literature on the safety and feasibility of ambulatory procedures in obese patients, and outline the specificity of this population.


RESULTS
During the last few years, the risks of perioperative complications in this population have been estimated more precisely, specifically respiratory events. A better knowledge of the pharmacology of anesthetic drugs in this population allows optimization of general anesthesia protocols and the interest of regional anesthesia has also been outlined. A first study on gastric banding has demonstrated the suitability of the ambulatory setting for such a procedure.


CONCLUSIONS
Ambulatory care in the obese patient is both feasible and well suited to this population provided a few specificities are taken into account.
Servin
Frédérique
F
Service d'Anesthésie-Réanimation, Hôpital Bichat, Paris, France. fservin@magic.fr
D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D000765:Anesthesia, Conduction / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D050110:Bariatric Surgery / Q000009:adverse effects; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D007442:Intubation, Intratracheal; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D012120:Respiration Disorders / Q000209:etiology; D018570:Risk Assessment; D017211:Treatment Failure; D020246:Venous Thrombosis / Q000209:etiology