Anesthesia for Contouring Body in Post-Bariatric Surgery Patient
Pp. 148-166 (19)
Marwan S. Rizk, Cynthia J. Karam and Chakib M. Ayoub
Obesity is a major health problem throughout the world. Its management by bariatric surgical
interventions is associated with a good success rate, leading to a necessary removal of excess skin after
weight loss. The popularity of bariatric surgery has created this new patient population characterized by
major anatomical and physiological changes with Massive Weight Loss (MWL) who still maintains
many of the co-morbidities of obesity. As a part of a multidisciplinary management, anesthetic
management of these patients should take the specific problems into consideration associated with
obesity and optimize them before surgery. All these factors such as physical changes, co-morbid
medical conditions (pulmonary, cardiovascular and metabolic changes such as vitamin deficiencies
etc.), airway difficulty, propensity for venous thrombosis, embolism, patient positioning, avoidance of
hypothermia, pharmacodynamics and pharmacokinetics of anesthetics and changes related to bariatric
surgery as well are all addressed in this chapter.
Another important aspect that is addressed is the role of regional anesthesia and its advantages over
general anesthesia for these patients, taking into consideration the difficulty in palpating bony
landmarks or even identifying the midline because of skin laxity and residual excess adipose tissue and
therefore neuroaxial blockade could be challenging.
Finally the postoperative management is optimized by development of clinical pathways involving the
surgeon, anesthesiologist, patient and support staff. Although obvious physical and physiological
improvement may be attained by such surgical procedures, the patient must be fully informed of the
multiple risks and complications inherent in such procedures.
Anesthesia in obese patients, body contouring, post massive weight loss surgeries, regional
anesthesia and landmarks, physiology in post MWL patients, phramacodynamics in post MWL patients.
Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.