الفهرس 
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Abstract
Obesity is considered a major health and socioeconomic problem. Morbid obesity is defined as BMI of 40 Kg/m2 or more. The etiology of morbid obesity is multifactorial including: genetic factors, eating disorders, behavioral changes, endocrinal causes and some psychiatric illness.
Diagnosis of morbid obesity can be done by several ways including clinical examination, calculation of BMI, measuring skin folds or imaging techniques.
Morbid obesity is associated with progressive and
serious co-morbidities such as respiratory problem, cardiovascular disease, type II diabetes, arthritis, endocrinal abnormalities and complications associated with pregnancy
and cancer.
Commonest respiratory problems in morbid obesity include obstructive sleep apnea that occur in 5% of all patients, where they suffer from hypoxemia, hypercapnia and pulmonary and systemic vasoconstriction. Hypoxemia leads to
secondary polycythemia and is associated with increased risk of ischemic heart disease, while hypoxic pulmonary vasoconstriction leads to right ventricular failure, also obesity is associated with decreased functional residual capacity, expiratory reserve volume and total lung capacity.
Cardiovascular problems as ischemic heart disease, hypertension and cardiac failure are common. Hypoxia, hypercapnia, electrolyte disturbance caused by diuretic therapy
and coronary heart disease may precipitate arrhythmias.
Treatment of morbid obesity includes conservative as medical treatment or surgical treatment (which is more effective) which may be open as gastric bypass, intestinal bypass and gastroplasty (which is divided into horizontal or
vertical banded gastroplasty) or laparoscopic as laparoscopic gastric bypass, laparoscopic vertical band gastroplasty or laparoscopic adjustable gastric banding.
Morbid obesity changes the management of anesthesia in every step starting from getting a venous access to maintaining adequacy of post extubation ventilation.
Great care should be taken in preoperative assessment.
Careful history, clinical examination and routine investigations together with special consideration to cardiovascular disease, pulmonary functions as well as endocrinal abnormalities as diabetes mellitus.
Proper monitoring of obese patients with routine
monitors, especially capnometry and pulse oximetry should be done. The ECG demonstrates the cardiac rhythm continuously.
Invasive arterial blood pressure monitoring and central venous catheterization can be used for morbid obese patients with cardiopulmonary disease.
Anesthesia for bariatric surgeries has been established with a broad usage of agents and techniques. General anesthesia using balanced anesthesia technique including intravenous induction agents as: thiopentone, propofol and
inhalational agents as isoflurane, desflurane and sevoflurane have been reported.
Variety of muscle relaxants including succinylcholine, atracurium, mivacurium and rocuronium can be used aiming at rapid recovery and cardiovascular stability.
A combination of balanced anesthesia using muscle relaxant, inhalational agent, intravenous and epidural narcotics and artificial ventilation combat the effect of surgical insult and the effect of pneumo-peritonium, namely the resorption of
carbon dioxide, diaphragmatic movement impairment and the reduction in lung volumes.
The most important complications facing obese patients postoperatively include respiratory problems, deep venous thrombosis, postoperative nausea and vomiting and wound infection.
Oxygen supplementation is essential postoperatively.
Adequate pain relief and measures to avoid deep venous thrombosis and pulmonary embolism should be taken including early ambulation. Postoperative admission to ICU may be required for careful monitoring of cardiovascular
function, respiratory function and administration of analgesia and oxygen therapy.