title: Preoperative evaluation and preparation of the morbidly obese patient.
abstract: OBJECTIVE
  This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach.
  
  
  RESULTS
  Preoperative evaluation should be carried out with sufficient time before the day of surgery to allow modification of the perioperative management. Medical history-taking and physical examination ought to be performed following a standardized scheme especially focussing on the presence of obstructive sleep apnea. Routine testing for fasting glucose and lipoprotein levels should be performed in order to diagnose a metabolic syndrome. ECG recording should be limited to those patients having one or more additional cardiac risk factors or presenting clinical signs of cardiovascular disease or were planned for intermediate or high-risk surgery. Spirometry should be limited to those patients with obstructive sleep apnea or other respiratory findings.
  
  
  CONCLUSIONS
  Synthesis of proper medical history-taking and physical examination as well as detailed search for obstructive sleep apnea and metabolic syndrome are key components of preoperative evaluation. Further testing should be based on the findings of these steps and comprise the cardiac risk of the surgical procedure.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Hospital Cologne-Merheim, Cologne Medical Center, Witten/Herdecke University, Cologne, Germany.
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Böhmer
authors.forename: Frank
authors.initials: F
authors.lastname: Wappler
mesh_terms: D000776:Anesthesiology / Q000379:methods* / Q000592:standards; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D004452:Echocardiography; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004562:Electrocardiography; D006801:Humans; D008487:Medical History Taking / Q000379:methods / Q000592:standards; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D010808:Physical Examination / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D013147:Spirometry