Bariatrics

Anesthesia for gastric bypass and similar weight-loss surgeries reminds me of the multisystem effects of morbid obesity on health. Although most patients presenting for these surgeries are young, they suffer many medical conditions as a result of their body mass. The anesthesia is higher risk because of gastroesophageal reflux, obstructive sleep apnea, a restrictive lung pattern, occasional right heart strain, and the effect of the abdomen on the diaphragm; as a result, they can be difficult to intubate and ventilate. Many patients have high blood pressure, diabetes, and hyperlipidemia. The hospitalization increases risk of venous thrombosis and pulmonary embolism. Of course, the surgery is meant to control the obesity which hopefully reduces the risk of all these other medical conditions.

Unfortunately, obesity is skyrocketing in our society today. There is a well-known public health map which colors all the states by rate of obesity.

This is from 2011. As you look back in the last twenty years, the colors have changed dramatically, indicating an overwhelming rise in body mass index. We keep on hearing how bad of a public health phenomenon this is, but it's simply not slowing. Whether the solution is to eliminate soft drinks from schools or to encourage daily exercise or to regulate fast food, I don't know.

But this is going to have huge implications for anesthesia. Obesity has real and significant risk for patients undergoing surgery. Although I think of bariatric surgery as gastric bypass, sleeves, and other weight-loss measures, the truth is, bariatric patients are getting all kinds of surgery. As anesthesiologists, we have to attend to these individual patients, but we also have a responsibility to advocate for public health measures, better education, and primary care services to slow this epidemic of obesity.