Anaesthesia for the morbidly obese. Experience with 110 patients

The anaesthetic management and postoperative complications of 110 grossly obese patients undergoing weight-reducing surgery have been reviewed. The major problems were technical, related to the bulk of the patient, and respiratory, caused by alterations in pulmonary physiology. Extradural catheters were placed in 70 patients before induction of general anaesthesia. In all patients the trachea was intubated during anaesthesia and the lungs ventilated with large tidal volumes and appropriate inspired oxygen concentrations. Muscle relaxation was achieved with extradural block in 35 patients; the remainder received pancuronium i.v. Extradural analgesia with bupivacaine provided excellent analgesia after surgery and greatly facilitated nursing care.