Department of Anaestesiology and Intensive Therapy
Medical University of Lodz
Head: prof. Wojciech Gaszynski
Author: Tomasz Gaszynski MD PhD, tel. +48 42 678 37 48,
e-mail: email@example.com ,
Overweight is recognized when Body Mass Index is over 25 kg/m2 , obesity - BMI over 30. Morbid obesity is met when BMI is over 40 or 35 with coexisting comorbidities. Superobese patient has BMI over 50 kg/m2 (picture).
Morbidly obese patients present many unique challenges to the anesthetist. In addition to problems with venous access, patient positioning and airway control, obesity is associated with many conditions, some of which have important implications for the administration of anesthesia.
There is an increase in the frequency of chronic diseases, such as diabetes mellitus, systemic arterial hypertension, hypertensive heart disease, gastroesophagal reflux, and cardiorespiratory complications such as obesity hypoventilation syndrome, obstructive sleep apnea syndrome, pulmonary arterial hypertension, and right and left ventricular failure. These conditions are very important during perioperative period. From anesthetic point of view, preoperative evaluation and optimization, transoperative management, and postoperative care represent a real challenge that may determine the success of the surgical procedure, the development of complications, and the final prognosis of the patient outcome.
Gastric bypass is one of the methods of surgical treatment of morbid obesity. In this procedure the stomach is divided transversally using TA-B stapler into two separated compartments. The upper, small part is later connected with the loop of small bowel. After about six months weight loss reaches 25-30% of initial weight. During next two years patients loose futher 25%. This method is most effective. There is no gaining weght after RYGB.
Cooperation between surgeon and anesthesiologist is essential in success outcome.
References on anesthetic management of morbidly obese: