title: [Perioperative anesthetic management of 300 morbidly obese patients undergoing laparoscopic bariatric surgery and a brief review of relevant pathophysiology].
abstract: OBJECTIVE
  Laparoscopic bariatric surgery is a challenge for anesthesiologists because morbidly obese patients are at high risk and laparoscopy may complicate respiratory and hemodynamic management. The aim of this study was to analyze the perioperative anesthetic management of morbidly obese patents undergoing laparoscopic bariatric surgery.
  
  
  METHODS
  Prospective study of 300 consecutive patients diagnosed with morbid obesity and scheduled for laparoscopic bariatric surgery. Patients were positioned with a wedge cushion under the head and shoulders. A rapid sequence induction of anesthesia was carried out. A short-handled, articulated-blade McCoy laryngoscope was used for intubation; an intubation laryngeal mask airway (Fastrach) was on hand as a rescue device. Propofol and remifentanil were used for maintenance of anesthesia and morphine was administered at the end of surgery. Incentive spirometry was initiated in the postanesthetic recovery unit.
  
  
  RESULTS
  Eighty percent of the patients were women with a mean (SD) body mass index (kg/m2) of 46 (5). The first choice of direct laryngoscopic intubation was successful in 98.6% of cases. All patients were successfully intubated. Only 5 patients required intensive care. Postoperative complications (mainly respiratory problems, bleeding, and infections) were observed in 17%. No patient died.
  
  
  CONCLUSIONS
  Perianesthetic management of morbidly obese patients who undergo laparoscopic surgery is safe. To minimize pulmonary complications, preoxygenation and rapid sequence induction should be performed correctly and incentive spirometry should be initiated in the immediate postoperative period. The McCoy laryngoscope ensures intubation in most cases.
authors: Unidad de Anestesiologfa, Reanimación y Terapéutica del Dolor, Hospital Infanta Cristina, Madrid. majosenavarro@hotmail.com
authors: M J
authors: MJ
authors: Navarro Martínez
authors: M L
authors: ML
authors: Pindado Martínez
authors: D
authors: D
authors: Paz Martín
authors: M
authors: M
authors: Caro Cascante
authors: M
authors: M
authors: Mariscal Flores
authors: J C
authors: JC
authors: Ruiz de Adana