Perioperative management of patient undergoing bariatric surgery

Abstract

Obesity is a increasing worldwide health problem which has a major pathological risk on the obese patients as central nervous system, cardiovascular, pulmonary, muscloskeletal, digestive and psychological implications. Bariatric surgery provide a significant and sustained weight loss option for obese patients which improve their quality of life and decrease the burden of diseases, bariatric surgery performed laparscopically as gastric balloning, sleeve gastrectomy, gastric banding and gastric bypass. The perioperative anaestheticassesment of the morbid obese patient is a challenging issue because of anatomical and pathophsiological changes, comorbidities and medication dosing, investigations and diagnosis of obesity related diseases as obstructive sleep apnea, cardiac arrythmia and cardiac chamber enlargement, repiratory function tests, beside risk assesment and informed consent should be fullfilled. Anticipation of difficult intubation and maintain patent airway protects the patient from major complications, intra operative monitoring, proper positionning should be meticuolus, pharmacodynamics and dosing of anaesthetic agents should be carefully calculated and proper dosed, using of short acting agent and multimodal analgesia and sometimes regional anaesthesia reduce postoperative respiatory depression and postoperative pain, postoperative complications as venous thrombo embolism, anastomosis leak, airway collapse, acute hemorrhage and neuropathy should be avoided by proper management and prophylaxis. pateint post operativelly should be admitted in high dependant unit which is familiar with handling with bariatrics or in ICU.