Anesthesia for morbid obesity

BACKGROUND AND OBJECTIVES: Morbid obesity is very frequent in our society, having achieved the level of an epidemic in the United States. Obese patients present several physiopathologic changes and important comorbidities, which the anesthesiologist must be aware of. Gastric reduction surgery is increasingly more frequent, and the perioperative period has unique characteristics, with cardiovascular and pulmonary changes that make it a real challenge for the professional involved. The hospital should also be prepared to receive those patients, with adequate equipment, a multidisciplinary team, and postoperative care. The objective of this study was to demonstrate that the patient with morbid obesity is not only a person with weight excess and, therefore, we attempted to describe the main conducts to be followed. CONTENTS: Here we present the main physiopathologic changes in the patient with morbid obesity, as well as the epidemiological data and correlated diseases. We review the doses of the drugs used in anesthesia, and the best pre, intra, and postoperative approach. CONCLUSIONS: The care of the patient with morbid obesity demands careful planning, which begins with patient selection, continues with a detailed preoperative and individualized intraoperative periods, and extends through the postoperative period, when the incidence of pulmonary, cardiovascular, and infectious complications is greater than in the non-obese population. The involvement of a multidisciplinary team, including Internal Medicine, Anesthesiology, General Surgery, Nursing, Psychology, Physical Therapy, Nutrition, and Intensive Care, is extremely important for good results.

DISEASES, Obesity; SURGERY, Abdominal

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil