Controversies in the Anesthetic Management of the Obese Surgical Patient

Excerpt

Despite the obesity epidemic, optimal anesthetic management of the morbidly obese remains unclear. To provide insight into the perioperative care of these complex patients, the editors have compiled the knowledge of international obesity experts for this relevant publication. Each chapter, written by a different set of experts, is presented as a controversy in the management of the morbidly obese. Part I of this five-part book serves as an introduction, with chapters on whether there should special training for managing morbidly obese patients and how to measure obesity and calculate drug dosages. Part II, titled “Preoperative Concerns”, includes chapters on preoperative considerations and preparation for the cardiac and respiratory systems, the consequences of diseases (e.g., diabetes, metabolic syndrome, and obstructive sleep apnea), the risk for gastric acid aspiration, and the benefits of preoperative physical therapy. Part III is concerned with the intraoperative management of the morbidly obese, with chapters on monitoring, positioning, airway management, induction of anesthesia, use of supraglottic airways, ventilation strategies, choice of anesthetic agent, fluid management, laparoscopic concerns, and the role of regional anesthesia. Part IV is concerned with postoperative management of the morbidly obese and includes chapters on where the morbidly obese should be cared for after surgery, the question of postoperative opioid therapy, and the role of analgesic adjuncts. Part V is a grouping of miscellaneous controversies which includes chapters on outpatient surgical centres, Cesarean delivery for the morbidly obese patient, and physiologic changes after bariatric surgery. …