Problems for the anaesthetist in the care of the obese patient

Abstract

On the basis of the literature available and observations of seventy-seven obese patients, it is concluded that the keynotes to survival of the obese patient during surgery, whether a minor or major procedure is anticipated, are as follows: (1) Ensurance of an unobstructed airway, by intubation awake if necessary. (2) Use of minimal intrathoracic pressures concomitant with effective ventilation or adequate spontaneous ventilation. (3) Positioning of the patient in a manner most suitable for ventilation and surgery. (4) Adequate monitoring of as many parameters as the situation demands. (5) Ensurance of adequate means of administering drugs and fluids at the rate and in the quantity that could conceivably become necessary. During the recovery period and convalescence, adequate pain relief and anti-nauseants may be combined with an active nursing program. It is of fundamental importance that, whatever technique is selected at this time, signs such as blood pressure changes, vocal activity, restlessness, and apparent sedation are each interpreted in the light of as many other details as possible, before what initially appears to be the appropriate course of action is taken. The vital thing during the postoperative period is accurate information at frequent intervals concerning the cardiovascular, respiratory, metabolic, and central nervous function of the patient. © 1968 Canadian Anesthesiologists.