Anesthesia for the bariatric patient: Optimizing safety and managing complications

Abstract

Patients undergoing bariatric surgery present many anesthetic challenges. In this chapter, we discuss various aspects of anesthetic management in this patient population. Predictors of difficult mask ventilation and difficult intubation, techniques to optimize preoxygenation, airway equipment, and criteria for extubation are addressed. Intraoperative monitoring, ventilation strategies, patient positioning, and injury prevention are also discussed. Morbid obesity affects the pharmacokinetics and pharmacodynamics of various anesthetic drugs, including induction agents, opioids, and muscle relaxants, requiring dosage adjustment. We introduce a multimodal pain management strategy to improve pain control and reduce side effects. Morbidly obese patients have a higher risk of postoperative respiratory complications, necessitating extra attention to postoperative management and disposition planning from the postoperative anesthesia care unit.