Anesthetic Challenges in Laparoscopic Bariatric Surgery

Abstract

Obesity is a condition of excessive body fat. The World Health Organization (WHO) classifies obesity based on BMI. Individuals with a BMI of 35 or greater who have concomitant obesity-associated disease or those with a BMI of 40 or greater regardless obesity associated diseases are at an increased risk of developing perioperative complications. In the UK, the National Institute for Health and Clinical Excellence (NICE) recommends bariatric surgery as an intervention when non-surgical measures for weight loss have failed to achieve or maintain clinically beneficial weight loss for at least 6 months. The field of bariatric surgery has expanded accordingly over the past decade. Obesity related co-morbidity increases the risk of perioperative complications, and morbidly obese patients presenting for bariatric surgery pose particular challenges to the anaesthetist. This assay addresses key issues relevant to preoperative assessment, and anesthetic management of morbidly obese patients presenting for bariatric surgery. The optimal extent and best timing for routine preoperative evaluation of patients presenting for laparoscopic bariatric surgery has not been conclusively studied. The objective of preoperative assessment is to optimize patient outcomes. It facilitates the appropriate selection of patients suitable for bariatric surgery, 􀂊 Summary 78 enables timely identification and treatment of pre-existing medical conditions, and determines how and where each patient should be managed post operatively. The bariatric multidisciplinary team (MDT) approach to pre-operative assessment ensures that patients are appropriately selected, informed and motivated, and optimized medically.