Anaesthesiological care in bariatric surgery

The number of patients suffering from morbid adiposity is on the increase in all industrialized and emerging countries. In concert with an extension of surgical options for morbid adiposity, this fact has resulted in a rise in the number of cases of bariatric surgery. However, quite apart from bariatric surgery in particular, general anaesthesiological management of the obese is also becoming more and more important.. Adiposity-associated morbidity such as diabetes, arterial hypertension, coronary heart disease, obstructive sleep apnoea and orthopaedic diseases makes the anaesthesiological management of these patients more difficult. The morphological changes due to adiposity often render the airway securement or vascular access difficult. Reliable and effective treatment of anaesthesiological complications, and postoperative analgesia pose a special challenge. In this review, the pathophysiology of morbid adiposity is outlined and strategies for safe, efficient anaesthesiological management in this special patient group are proposed.