What are the important perioperative risk factors for morbidly obese patients?

Abstract

Obesity, even in its severe form, has become a common feature among patients presenting for surgery. From experience with bariatric surgical and obstetrical patients, clinicians have developed some expertise in the perioperative care of these obese patients. However, clear and evidence-based guidelines for comprehensive pre-, intra- and postoperative approaches are still lacking. Extrapolation of recommendations created for the general surgical patient population irrespective of body weight considerations currently serve as a guide to the management of obese patients. However, additional unique concerns apply for patients who are extremely or morbidly obese (MO). This chapter highlights three distinct, yet interconnected conditions often associated with severe obesity, and draws the clinician's attention to their perioperative implications. For the MO patient, the anesthesiologist's high index of suspicion during the preoperative evaluation should focus on the presence of the metabolic syndrome (MetS), sleep disordered breathing, and cardiovascular co-morbidities. Each of these entities may have silent or non-specific symptoms, yet they may affect the entire perioperative care process.