AIM: The aim of this work is to know the pathophysiological mechanism of critically ill obese patients and to recognize the new requirements for their management in the critical-care-setting. The obese patient's category is still increasing in many westernized countries especially the united states (USA). As a result, the peri-operative management of obese patients became routine care. As obese patients are now liable for all types of procedures, it is essential and very important for all anesthesiologists, surgeons, perioperative-health care providers to understand their different multi-organ physiology so as to safely prepare those obese patients perioperatively. A good assessment of those patients pre-operatively can decrease the risk of postoperative complications later on …, in this manuscript, we mention the major considerations for the preoperative assessment of morbidly obese patients. Obesity now became the main cause of increased morbidity and mortality because of acute and chronic medical diseases, like diabetes mellitus, hypertension, cardiovascular problems, renal disorders, arthritis, and certain types of cancer (Mokdad et al. 2003). Obese patients, particularly morbidly ones, have a higher percentage of resource utilization, intensive care unit entrance, respiratory diseases, and respiratory distress syndrome, than do nonobese patients (Westerly and Dabbagh2011). also, obese patients are at higher danger for postoperative complications
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