الفهرس 
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Abstract
Obesity represents a significant and growing probem around the globe. Bariatric surgery, which is continuously in development, is an acceptable alternative treatment option for obese individuals. It has been performed to provide weight loss and improved quality of life, as well as to decrease the risk of obesity-related disorders. A wide range of available surgical techniques, including intragastric balloon, biliopancreatic diversion, gastric plication, sleeve gastrectomy, and roux-en-Y anastomosis, have been performed on patients with morbid obesity (BMI >40 kg/m2) or severe obesity (BMI >35 kg/m2). While invasive approaches have been associated with better clinical results, such as consistent weight loss and co-morbidity resolution, their disadvantage is an increased risk of perioperative mortality.
The medical history and clinical findings for preoperative anaesthetic evaluation are important because of many comorbidities as smoking, hypertension, thromboembolism, limited functional status, sleep apnea, hypoalbuminemia ,coronary artery disease, stroke, bleeding disorder, dyspnea, chronic corticosteroid use, pulmonary hypertension, liver disease, congestive heart failure, cardiac arrhythmia, increased respiratory resistance, increased work of breathing, reduced lung volumes, increased resting heart rate, increased resting cardiac output, increased ventricular wall thickness.
Obese patients, undergoing bariatric or other surgical procedures, present an increased anesthetic risk because of physiologic changes, co-morbidities and technical challenges . The implications for anesthetic and perioperative care of these patients are considerable, and are believed to escalate in the presence of co-morbidities.
Careful assessment of a patient’s comorbidity status should be made and their comorbidities optimized prior to surgery. Obese patients have higher anaesthetic risk than non-obese patients due to an increased burden of disease and the physiological impairment associated with obesity. Multiple aspects of the anaesthetic process should be considered in patients undergoing bariatric surgery.
Well-established guidelines regarding preoperative risk stratification have led to improved surgical outcomes. These standards remain useful in the appraisal of the obese patient. There is evidence that obesity itself is a surgical risk factor. Both the predictors of morbidity and mortality after bariatric surgery and the complications of the surgery may be unique to the morbidly obese population, that is, those with a body mass index (BMI) greater than 40. Ironically, it seems that the very population for whom bariatric surgery is indicated and beneficial may be at increased risk for having the surgery because of excessive weight.
It is essential for the bariatric surgeon to carefully assess each prospective surgical candidate from medical, surgical, and behavioral perspectives, and then comprehensively prepare those patients. In addition, during and after surgery, these patients require a high degree of attention and surveillance. Understanding the unique requirements of this patient population and providing the appropriate attention to details is vital for minimizing the risk of complications and maximizing the potential for a good start on the long road to weight loss and improved health.
Only a few studies have attempted to define predictors of outcomes in morbidly obese patients for either bariatric or non bariatric surgery. Early mortality in the bariatric patient has been linked both to preoperative patient characteristics and to perioperative complications. Adverse events most common to bariatric surgical patients include pulmonary embolism, pneumonia, anastomotic leaks, marginal ulcers, wound dehiscence, and small bowel obstruction. Lastly, the greater the BMI preoperatively, the more likely that a patient will sustain these poor outcomes.
Morbidly obese patients present special risks for the anesthesiologist. All co-morbid conditions should be evaluated and optimized prior to these elective procedures. This requires a team approach and adequate communication among the surgical team members and anesthesia providers. Overall, laparoscopic surgery confers definite advantages for the morbidly obese population. Awareness of and preparation for the unique needs and problems of morbidly obese patients undergoing either open or laparoscopic surgery will optimize outcomes and minimize anesthesia-related complications.
So careful planning, preoperative risk assessment, adequate anesthetic management, strict venothrombotic event prevention, and effective postoperative pain control will all help to improve outcomes and reduce the risk of perioperative mortality.