New Trends in Anesthetic Management of Morbidly Obese Patients

Abstract

SUMMARY O besity is a global health problem which steadily increasing. It is one of the preventable causes of death as it is a multi-system disorder, particularly involving the respiratory and cardiovascular systems. Etiology of obesity is multifactorial it is an interplay between genetic, environmental, metabolism, behavioural and social determinants. Mainly lack of physical exercise and increase caloric intake leads to obesity. There are many hazards for obesity health consequences which fall into two categories, those attributable to the effects of increased fat mass (osteoarthritis, obstructive sleep apnea, social stigmatization) and those due to increased number of fat cells (diabetes, cancer, cardiovascular diseases and non alcoholic fatty liver). Increased fat also creates a pro-inflammatory state and so increased incidence of thrombosis. High percentage of obese patients undergo surgical procedures either bariatric surgeries after failure of diet control and medications or other non bariatric surgeries. There is a myriad of anesthesic challenges associated with these surgeries Airway assessment is mandatory due to increased incidence of difficult ventilation and intubation. Recommended preoperative labs include blood glucose lipid profile serum chemistry, ECG, echo pulmonary function tests are recommended. Narcotics as a premedication is preferred to be avoided, but H2-blockers neublizers and thrombo-embolic prophylaxis are recommended. Anesthesia care team must be available for airway management, positioning, monitoring, choice of anesthetic technique, anesthetic agent pain control and fluid management. These issues are equally important during operation, recovery and postoperative period. Two major postoperative complications are pulmonary complications which can be avoided by optimization of lung condition before the surgery, intraoperative recruitment and use of PEEP and close postoperative monitoring of any signs of respiratory decompensation, and thromboembolic events which can be avoided by intra and postoperative anticoagulation and early mobilization.