American University of Beirut Medical Center, Lebanon
Samar Jabbour-Khoury has completed her medical degree at University of Damascus-Medical School and Mouassat University Hospital with high distinction. She then finished her residency in anesthesia between the American University of Beirut Medical Center and St. Mary’s Hospital, UK. She is currently a professor at the Department of Anesthesiology at the American University of Beirut Medical Center and the coordinator of the Transplant Team at this center. She has published more than 40 papers in reputed journals. She also has in progress a study concerning bariatric surgery entitled: “Intraoperative Dexmedetomidine versus Morphine for Postoperative Analgesia after Laparoscopic Bariatric Surgery”.
Obesity, an excess of body fat, is defined as a BMI (body mass index) of more than 30 kg/m2. Due to the modern sedentary lifestyle, its prevalence is increasing in the developed countries. This has led to additional healthcare costs, with the accompanying increased comorbidities and mortalities. Obese patients are now more frequently encountered in the perioperative setting for different kinds of surgeries. Special training of personnel and special equipments and considerations should take place. The preoperative assessment is multidisciplinary with special attention to cardiac and pulmonary comorbidities that place the patient at a higher risk perioperatively (hypertension, coronary artery disease, obstructive sleep apnea). Intraoperatively, difficulty in obtaining an intravenous access and in securing the airway is frequently encountered. Regional anesthesia is also challenging. Positioning the patient poses an issue for us too. The anesthetist should also be aware of the altered drug metabolism in the obese patients. Postoperatively, many concerns are present such as the type of analgesia, respiratory support and deep venous thrombosis prophylaxis.
Bariatric surgery has gained popularity nowadays and is a definitive treatment for the morbidly obese. Concerning the anesthetic management, the author will be talking about its many considerations perioperatively. She will also be discussing the common postoperative complications and their management. Some common nutritional deficits will be overviewed. Finally, obesity is a major healthcare challenge especially for the anesthesiologist. A thorough understanding of its pathophysiological changes and its perioperative implications is of vital importance. Bariatric surgery is a beneficial and cost-effective clinical intervention to improve the quality of life of this population with resolution of the associated comorbidities.
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