Anesthetic Management for a Patient Undergoing Bariatric Surgery

Abstract

Obesity is considered a major health and socio-economic problem. Overweight, obesity and morbid obesity are terms often used to describe individuals with an increased body fat. The most common definition of morbid obesity is a body mass index (BMI) of 40 Kg /m2 or more. The etiology of this condition is multifactorial including; familial and genetic predisposition, drug induced obesity, endocrinal causes, childhood overnutrition, intake of food in large quantities and many times in the day, psychological factors, environmental factors, special habits like alcohol consumption and smoking and personal factors like; age, gender, ethinity and parity. Clear understanding of the pathophysiology of morbid obesity is essential for management and prevention of this disaster. There are several factors concerning the occurrence of obesity, the first one is the genetic control also central nervous system control , afferent signals, pattern of feeding, socio-economic factors, exercise and pattern of distribution of excess adipose tissue. There are many disastrous diseases associated with morbid obesity including; cardiovascular diseases, diabetes mellitus, respiratory problems, digestive diseases, arthritis, chronic abdominal compartmental syndrome, hernia, infectious problems, endocrinal abnormalities, psychological problems, complications associated with pregnancy, cancer, neurological complications and other medical problems compounded by obesity. Approximately 5% of morbidly obese patients may have obstructive sleep apnea syndrome. Recurrent attacks of apnea during sleep leading to hypoxemia, hypercapnia and pulmonary and systemic vasoconstriction. Recurrent hypoxemia leads to secondary polycyathemia and is associated with an increased risk of ischemic heart disease, while hypoxic pulmonary vasoconstriction leads to right ventricular failure.