الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Summary
Obesity is an excess of body fat that frequently results in a significant impairment of health but, in simple terms, occurs when net energy intake exceeds net energy expenditure over a prolonged period of time.
According to the National Institutes of Health, obesity is a major health problem with clearly established health implications.
Each year more people are becoming overweight, increase in comorbidity and decrease in life span are being seen in our population so the anesthetists are commonly face the challenge with the obese patients.
Challenges that face the anesthesiologist are started earlier than we expect; Challenges in starting intravenous lines (difficult to visualize or palpate veins), positioning supine (which predisposes to hypoxemia), ventilation by mask (difficult) and using highly lipophilic drugs (prolonged effects) are just some of the issues.
A systematic understanding of the pathophysiology and specific complications associated with the condition should allow more effective and safer treatment for this unique group of patients.
Surgical approaches designed to treat obesity can be classified as malabsorptive or restrictive. RYGB (roux-in-Y Gastroplasty), the ″gold standard ″ of bariatric operations, combines gastric restriction with a minimal degree of malabsorption. It can be performed laparoscopically.
Gastroplasty separates the stomach into a small upper pouch (15-30 ml), which restricts food intake. This pouch communicates with the remainder of the stomach through a narrow channel, or stoma.
Anaesthesia for laparoscopy has been established with a broad usage of agents and techniques. General anaesthesia using balanced anaesthesia technique including intravenous induction agents like: Thiopentone, propofol, etomidate, and inhalational agents like: Nitrous oxide, isoflurane, Desflurane has been reported.
Variety of muscle relaxants including succinylcholine, mivacurium, atracurium, vecuronium aiming at rapid recovery and cardiovascular stability.
A combination of balanced anesthesia using muscle relaxant, intravenous and epidural narcotics and artificial ventilation fight the effect of surgical insult and the effects of pneumoperitoneum, the resorption of carbon dioxide, diaphragmatic movement impairment and the reduction in lung volumes.
Preparation should be made for the possibility of a difficult intubation, and a surgeon familiar with surgical airways should be readily available. A towel or folded blankets under the shoulders and head can compensate for an exaggerated flexed position from posterior cervical fat. The object of this maneuver, known as “stacking,” is to position the patient so that the tip of the chin is at a higher level than the chest, to facilitate laryngoscopy and intubation.
Invasive arterial monitoring should be used for the super morbidly obese with severe cardiopulmonary disease giving continuous records of blood pressure and the blood gases estimation when is needed. The CVP helps in assessing the preload status.
While the ECG demonstrated the rhythm status continuously. The recommended prophylactic heparin use is in accordance with prevention of deep venous thrombosis and subsequent pulmonary embolism. The use of intermittent inflated pneumatic cuff compression helps in maintaining circulation in the legs during the operation.
Nutritional supplements, special formulated, are required for those who have had Bariatric Surgery. Gastric Bypass surgical patients must take supplements for the rest of their lives in order to maintain their health. Serious problems can occur if required vitamins and minerals are not taken daily.
Bariatric surgery is a safe and viable option in the management of obese patients when nonsurgical treatment options have been unsuccessful. Anesthetic management of these patients should take into consideration the specific problems associated with obesity and optimize them before surgery.
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