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.