Controversies in perioperative anesthetic management of the morbidly obese: I am a surgeon, why should I care?
Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.
Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, PA, USA, Ashish.Sinha@drexelmed.edu.
Ashish C
AC
Sinha
Preet Mohinder
PM
Singh
D058109:Airway Management; D000714:Anastomosis, Surgical; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000777:Anesthetics; D050110:Bariatric Surgery; D045422:Continuous Positive Airway Pressure; D003920:Diabetes Mellitus / Q000453:epidemiology; D006801:Humans; D009017:Morbidity; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D010149:Postoperative Pain / Q000517:prevention & control; D056888:Patient Positioning; D018579:Patient Selection; D019990:Perioperative Care; D018570:Risk Assessment
D000777:Anesthetics