Chapter 9 - Anesthesia for Bariatric Surgery

Abstract

There is a global pandemic of obesity. Bariatric surgery patients are a major subgroup of the morbidly obese. However, despite the significant comorbidities in this cohort, the 30-day mortality rate after elective bariatric surgery is low (0.3%). An estimation of individual patient risk of postoperative complications is made by the patient’s anesthetist and surgeon during their preoperative assessments. This assessment guides the perioperative management of patients having bariatric surgery, which is described in this chapter. As the prevalence of obesity increases, anesthetists will be more frequently confronted with obese patients undergoing nonbariatric surgery. The principles of the perioperative management of the obese patient having bariatric surgery described in this chapter can be applied to any obese patient having any elective surgery and vice versa. Coverage includes the following areas: (1) physiological changes (respiratory and cardiovascular); (2) dosing with anesthetic drugs; (3) intraoperative anesthetic management (monitoring, choice of anesthetic, preparation for induction, induction, airway management, patient positioning, maintenance of anesthesia, ventilation management, fluid management, extubation); and (4) postanesthesia care unit management (monitoring, ventilation, management of pain and anxiety, criteria for stepdown from the postanesthesia care area).