Abstract

Obesity is a major health problem throughout the world. Its management by bariatric surgical interventions is associated with a good success rate, leading to a necessary removal of excess skin after weight loss. The popularity of bariatric surgery has created this new patient population characterized by major anatomical and physiological changes with Massive Weight Loss (MWL) who still maintains many of the co-morbidities of obesity. As a part of a multidisciplinary management, anesthetic management of these patients should take the specific problems into consideration associated with obesity and optimize them before surgery. All these factors such as physical changes, co-morbid medical conditions (pulmonary, cardiovascular and metabolic changes such as vitamin deficiencies etc.), airway difficulty, propensity for venous thrombosis, embolism, patient positioning, avoidance of hypothermia, pharmacodynamics and pharmacokinetics of anesthetics and changes related to bariatric surgery as well are all addressed in this chapter.

Another important aspect that is addressed is the role of regional anesthesia and its advantages over general anesthesia for these patients, taking into consideration the difficulty in palpating bony landmarks or even identifying the midline because of skin laxity and residual excess adipose tissue and therefore neuroaxial blockade could be challenging.

Finally the postoperative management is optimized by development of clinical pathways involving the surgeon, anesthesiologist, patient and support staff. Although obvious physical and physiological improvement may be attained by such surgical procedures, the patient must be fully informed of the multiple risks and complications inherent in such procedures.