The worldwide prevalence of obesity has increased dramatically in recent years. Since the results of long-term dietary behavioral therapy remain sadly inadequate, surgery is currently the only effective treatment for patients with severe or morbid obesity. The numbers of weight loss operations continue to increase annually throughout the world. The anesthetic management of severely obese patients entails special challenges, especially when medical co-morbidities are present. Published outcome data on anesthetic care and pain management of these patients are scarce, and many practices remain controversial. Controversies in the Anesthetic Management of Obese Patients considers a wide range of important practical issues. Key questions in preoperative, intraoperative, and postoperative management are addressed, and different approaches are evaluated. Written by international leaders in the field, this book will be an invaluable aid for anesthesia care providers.

Zusammenfassung
The prevalence of obesity, an important risk factor for various diseases, has increased markedly worldwide in recent years. The results of long-term dietary behavioural therapy, however, remain sadly inadequate, with a relapse rate of about 90%. Surgery is still the only effective treatment for these patients. The annual number of weight loss operations performed in the United States in the early 1990s totaled only about 16,000, but by 2005 the figure exceeded 200,000. The anesthetic care of severely obese patients entails particular issues, and difficulties are believed to escalate in the presence of co-morbidities. Despite this, outcome data in respect of anesthetic care and pain management are still scarce. Anesthetic Management of the Obese Patient considers a wide range of important practical issues and controversies. Key questions in preoperative, intraoperative, and postoperative management are carefully addressed, and different approaches are evaluated, casting light on their effectiveness and limitations. Written by world leaders in the field, this book will be an invaluable aid for anesthesiologists.

Inhalt

SECTION 1: Introduction

**1.**Should Anesthesiologists Managing Morbidly Obese Patients Receive Special Education and Training?

**2.**How should obesity be measured and how should anesthetic drug dosage be calculated? ****

SECTION 2: Preoperative Concerns

3.What are the Important Perioperative Risk Factors for Morbidly Obese Patients?

4. Does Every Morbidly Obese Patient Need a Complete Preoperative Workup?

5. What Should an Anesthesiologist Know about the Metabolic Syndrome?

6.Is a Full Cardiac Workup Indicated For Morbidly Obese Patients With Cardiac Disease? ****

7.How and When Should Diabetes in the Obese Patient be Treated?

8.How Should You Manage Anti-Hypertensive Drugs in Morbidly Obese Surgical Patients?

9. Should all Morbidly Obese Patients be Evaluated for Obstructive Sleep Apnea?

10.Are Morbidly Obese Patient at Increased Risk for Gastric Acid Aspiration? ****

11. What is the role for pre-operative physical training and respiratory kinesitherapy in obese surgical patients?

SECTION 3: Intraoperative Management

12. Which Intraoperative Monitors are Essential for the Obese Surgical Patient?****

13. What is the Optimal Position for Induction of Anesthesia for a Morbidly Obese Patient? **

14. Do all Morbidly Obese Patients have a Difficult Airway?****

**15.**What is the Best Way to Induce General Anesthesia in Obese Patients?

**16.**Do Supraglottic Airways have a role in the Anesthetic Management of Obese Patients?

**17.**Is Protective Lung Ventilation Safe in Morbidly Obese Patients? ****

**18.**Does choice of inhaled anesthetic agent matter?

19. What is Optimal Fluid Management of the Obese Surgical Patient?****

20. What are the Challenges of Laparoscopy in Morbid Obese Patients?****

21. Is there a role for regional anesthesia in the obese patient?

SECTION 4: Postoperative Concerns

22. Should obese surgical patients be recovered in an ICU or PACU? Should all postoperative MO patients be monitored during their entire hospitalization?

23. Is opioid analgesia safe after surgery? **

24. What is the Role of Analgesic Adjuncts in Obese Patients?

SECTION 5: Other Controversies

25. Can Morbidly Obese Patients Safely Undergo Surgery at an Outpatient Surgery Center?

26. What Physiological Changes Occur After Bariatric Surgery and Are They Important to the Anesthesiologist?

**27.**Which anesthetic (general or regional) is safest for a caesarean-section in a morbidly obese parturient?

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