Introduction
The word obesity is coined from a Latin word obesus, which means fattened by overeating. Body mass index (BMI) is the most commonly used epidemiological tool to assess obesity, which is obtained as follows:
BMI = body weight (kg)/height (metre2).
Other useful terms are as follows:
Ideal body weight (IBW) in kg = height (cm) – 100 in males and 105 in females.
Lean body weight (LBW) = total body weight, excluding body fat.
The WHO classification of obesity is summarized in Table 27.1.
Abbreviation: BMI, body mass index.
The number of obese individuals is on the rise worldwide, and so is the number of patients reaching to the operation theater. An obese patient may come for weight-reduction surgery (bariatric surgery) or nonbariatric surgery. The anesthetic management of obese individuals is often challenging and complicated because of multiple comorbidities and associated difficult airway. The various medical and surgical diseases related to obesity are mentioned in Table 27.2.
Anesthetic Management of Obese Patients
Minimally invasive surgical treatment (bariatric surgery) is increasingly popular worldwide. The surgical procedure can be classified into the following:
Restrictive type (sleeve gastrectomy, laparoscopic adjustable gastric banding).
Malabsorptive type (jejunoileal bypass, biliopancreatic diversion).
The goal of surgery is to reduce the volume of the stomach in order to achieve desired weight loss. A thorough preoperative evaluation of the obese patient with a focus on cardiovascular system, respiratory system, and airway is necessary.
Preoperative Assessment
It is important to assess the patient, taking into account his general and systemic well-being.
General Assessment
Height and weight should be measured to calculate BMI. The LBW and adjusted body weight to be calculated for accurate dosing of drugs.
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