[Anesthesia problems in extreme obesity]

Obese patients show a markedly increased perioperative morbidity and mortality. Due to the severe impairment of his cardiopulmonary system the extremely obese patient is at high risk. Among the abundant pathophysiologic disorders which in less severe form can also be traced in minor obesity, are reductions in functional residual capacity and total compliance as well as oxygen costs of breathing that are increased by a factor of 4-16. On the basis of current knowledge of these pathophysiologic disorders guidelines for the management of the obese patient in the perioperative period are proposed.