Anesthetic management of the morbidly obese patient

Anesthetic management should concentrate on various aspects of pre-, intra-, and postoperative care. Particular laboratory studies, such as arterial blood gases, electrocardiogram, selected pulmonary function tests (e.g., ERV), and serum hepatic profile, can be quite useful. Preoperatively, technical difficulties (intravenous and arterial cannulae, operative positioning, and airway assessment), psychologic considerations, and response to preanesthetic medications can be anticipated. Intraoperative concerns encompass the choice of regional versus general anesthesia, anesthetic biotransformation, and variables influencing intraoperative oxygenation (e.g., effects of general anesthesia, operative position, abdominal packing). Postoperative concerns are directed toward minimizing postoperative hypoxemia, peripheral phlebothrombosis, and fluid imbalances. Special caution is needed in operations subsequent to jejunoileal bypass surgery. Specific choices of anesthetic agents and techniques await further clinical and laboratory investigations in this unique subset of the population.