Anesthetic management of morbidly obese patients

Abstract

BESITY, derived from the Latin word obesus, meaning fattened by eating, is a condition of excessive body fat. ~ It is often difficult to distinguish between normal and excessive amounts of fat tissue, but when physical and mental health are affected by increased amounts of fat tissue and life expectancy is reduced, a person can be considered obese. 2 The anatomic distribution of body fat is associated with varying pathophysiologic consequences. 3-5 In android or central obesity, adipose tissue is located predominantly in the upper body (truncal distribution) and is associated with increased oxygen consumption and increased incidence of cardiovascular disease, whereas in gynecoid or peripheral obesity, adipose tissue located predominantly in the hips, buttocks, and thighs is less metabolically active so it is less closely associated with cardiovascular disease. 3 Intraabdominal fat distribution appears to be particularly associated with cardiovascular risk 4 and left ventricular dysfunction. 5 Obesity has a multifactorial origin, influenced significantly by genetic, ethnic, socioeconomic, and endocrine factors. 6 Ideal body weight (IBW) describes the weight associated with the lowest mortality rate for a given height and gender, and it can be estimated by using the Broca index: IBW (in kg) = height (in cm) - X, where X is 100 for adult men and 105 for adult women. 6'7 Normal values are individualized based on height. In clinical practice, body mass index (BMI) is used to estimate the degree of obesity.