Anesthesia Considerations in the Obese Patient for Bariatric Surgery

Abstract

Provision of bariatric surgery in the United Kingdom (UK) has grown exponentially since the turn of the century with consequent increase in the requirement of anesthesia for morbidly obese patients. In this chapter we outline key considerations for safely managing this challenging patient group and highlight areas where care may differ from standard anesthetic practice. Particular consideration is given to the importance of specialist anesthetic involvement in a multidisciplinary team (MDT) working at the pre-assessment clinic and the value of a team-based approach throughout the care pathway. We outline the importance of ensuring the availability of basic equipment such as large chairs, patient gowns, high-weight theatre tables and electric beds.

Effective preoperative assessment and investigations are outlined with discussion of determining appropriate levels of postoperative care. Particular mention is made the importance of identifying and optimizing obstructive sleep apnea, heart failure and metabolic disease. Anesthetic techniques are discussed including correct positioning of patients prior to anesthesia, pre-oxygenation and determining appropriate drug regimes aiming for short acting agents with sparing opioid use. Morbidly obese patients are at higher risk of venous thromboembolism than the general population. Suggestions are made for minimizing the risk.

Anesthesia for bariatric surgery in the UK is very safe, but the margin for error is small. Patient safety is best assured by meticulous attention to detail, appropriate training and care delivered by experienced staff.