Perioperative care of the obese patient

Abstract

Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

<p>Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery</p>

“…The association of obstructive sleep apnea (OSA) with obesity is quite common. 41,42 There is a high prevalence of OSA in the surgical population, however, a significant proportion of patients are undiagnosed. 43 Therefore, preoperative OSA screening is crucial in the obese patient.…”

Perioperative management of a morbidly obese patient undergoing right upper lobectomy with poor pulmonary function: a case report

“…Rehabilitation and treatment strategies have been undertaken to reduce the incidence of perioperative complications for morbidly obese surgical lung cancer patients with COPD with poor pulmonary function (12,13). In the present case, due the patient's medical history of morbid obesity and COPD, a 2-week rehabilitation program before surgery was conducted to improve respiratory function.…”

“…First, some perioperative rehabilitation and treatment plans were not implemented rigorously. For example, before surgery, patients should be encouraged to lose weight (5-10% body weight) to prevent or treat obesity-related complications and to improve the surgeon's operating conditions (12,16). In our case, a low-calorie diet was used to control the patient's weight, but the patient only lost 2% body weight before surgery.…”

Is There a Role for ERAS Program Implementation to Restart Bariatric Surgery After the Peak of COVID-19 Pandemic?

“…We need safe and low-infection risk pathways of care in our hospitals. Some help could come from the extensive use of ERAS protocols in bariatric surgery, which has been conceived to reduce length of hospital stay and to promote early functional recovery [18][19][20][21][22][23]. Reducing hospitalization can reduce infection risk.…”