Perioperative and Anesthesia Considerations in Obese Patients

Is Airway Management More Risky in Bariatric Surgery?

PURPOSE

Airway problems may be experienced more often during anesthesia management in bariatric surgery. In this prospective study, we aimed to compare the incidence of difficult ventilation and intubation between bariatric surgery and other surgeries.

DESIGN

This was a case-control study.

METHODS

Medical records of 156 patients over the age of 18 who were scheduled for bariatric (n = 68) and nonbariatric surgery (n = 88) under general anesthesia were evaluated.

FINDINGS

The percentage of ASA III, Diabetes Mellitus, and Obstructive Sleep Apnea Syndrome (75%, 33.8%, and 16.2%, respectively) was significantly higher in bariatric surgery patients compared to nonbariatric patients (14.8%, 10.2%, and 3.4%, respectively). No significant difference was found in mean thyromental distance and history of difficult intubation, restriction of cervical extension, beard presence, tooth loss, mallampati, Cormack-Lehane score, intubation score, difficult ventilation, difficult intubation and intubation device used. An increase in neck circumference (>50 cm) rather than body mass index was a more significant indicator in predicting difficult intubation and difficult ventilation.

CONCLUSIONS

The incidences of difficult ventilation and difficult intubation were similar in bariatric and nonbariatric surgeries in circumstances where the necessary equipment and experienced anesthesiologists are available.

Pulmonary aspects of obesity in critical care

Critically ill obese patients have many challenging pulmonary problems. The first key is to understand pathophysiology in the pulmonary system related to obesity. Second, it is important to identify the altered physical assessments and diagnostics that occur because of the pulmonary pathophysiology of obesity. Lastly, one should be aware of medical and nursing intervention options that treat symptoms or pulmonary problems of obesity. This article summarizes pulmonary issues related to obesity in critical care.

Current world literature

This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 February 2008 and 31 January 2009 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.

A perioperative team approach to treating patients undergoing laparoscopic bariatric surgery

WHEN A PATIENT IS OBESE, simple dieting and exercise are rarely able to reverse significant comorbidities. Currently, surgery is the most effective treatment for obesity with respect to the amount and duration of weight loss. BARIATRIC SURGERY REQUIRES a team approach in a clinical setting capable of supporting all aspects of management and assessment. THE PATIENT IS THE CENTER of the team's focus, and all facets of the perioperative process are interconnected. The words coordinate, educate, accommodate, facilitate, and communicate describe the multidisciplinary process that is necessary to provide quality, safe patient care with positive outcomes.