[Anesthesia and obesity]

Problems encountered during anesthesia procedures in obese subjects is related to the level of overweight. Obesity multiplies the effect of general anesthesia on the respiratory function and increases the postoperative risk of cardiovascular disorders and deep vein thrombosis. The pharmacokinetic behavior of most general anesthesia drugs is affected by the mass of adipose tissue producing a prolonged less predictable effect. Control of airway permeability and continence is also a major problem with predictable or unpredictable difficulties with endotracheal intubation. Locoregional anesthesia, which avoids the intubation problem, is difficult to implement and does not provide satisfactory results in all cases. The preoperative work-up should assess the consequences of obesity, particularly concerning the respiratory, cardiovascular, and metabolic systems. A proper work-up allows the anesthesist to provide the obese subject with well-informed information on the risk and benefit of proposed options.