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Anesthesiology:
doi: 10.1097/ALN.0b013e31821cf4d9
Reviews of Educational Material

Perioperative Anesthetic Care of the Obese Patient

McGlinch, Brian P. M.D.
Section Editor(s): Avram, Michael J. Ph.D.; Editor

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Edited by Vilma E. Ortiz, M.D., and Jeanine Wiener-Kronish, M.D. New York, Informa Healthcare USA, Inc., 2010. Pages: 234. Price: $300.00.
Obesity affects all aspects of perioperative care in all age groups. Obese patients undergoing bariatric surgery typically have thorough preoperative evaluations and preconditioning preparations, making their anesthetic management routine. The clinical anesthesia challenge is that most morbidly obese patients having surgery do not undergo bariatric procedures. As a result, anesthesia providers are faced with both technical and clinical challenges in managing morbidly obese patients for procedures not involving weight loss, often without sufficient experience or insight into mitigating risk beyond those related to airway management.
Perioperative Anesthetic Care of the Obese Patient provides an extraordinary amount of relevant information regarding obesity that is easily digested and applied in most perioperative settings. This informative and concise textbook is divided into sections (Preoperative, Intraoperative, Postoperative, and Special Situations), with each section addressing important clinical and physiologic aspects of care encountered in that venue. The editing is exceptional in that very little repetition or conflicting information is presented, and the information is well organized and thoughtfully presented.
In the Preoperative section, each organ system is represented from the perspective of basic physiology and the organic dysfunction resulting from obesity. The information presented emphasizes observations reported from recent, obesity-related human studies relevant to a particular organ system. This section effectively balances basic science background and clinical studies, allowing the clinician an unbiased presentation of information relevant to obesity and anesthetic management. A busy clinician can reference a particular chapter and quickly access useful information, making this a valuable reference tool in clinical practice.
The Intraoperative section is as useful and relevant as the preceding one. Obesity creates a challenging environment for anesthesia personnel, not only because of the need for appropriate drug dosing but also for issues related to positioning, monitoring, and regional anesthesia procedures. These topics are concisely and thoroughly presented. Much like the Preoperative chapters, the Intraoperative chapters emphasize clinical studies without becoming a “How To” atlas. I believe the great beauty of this book is that the reader is given the information necessary to understand the relevant challenges of intraoperative management of the obese patient without being distracted by authors advocating their point of view. The important issues are distilled, presented to the reader without bias, and can be readily referenced if intraoperative issues arise in clinical practice.
The Postoperative section reaffirms the fact that obese patients present unique challenges (respiratory, infection, analgesia, and thromboembolic) after surgery but not necessarily greater morbidity or mortality. Postoperative management (e.g., oxygen therapy, ambulation, deep venous thrombosis prophylaxis, and analgesia) of the obese patient is certainly more difficult than in the physically fit patient. However, in terms of morbidity and mortality of the obese patient after surgery, there are no overwhelming data suggesting the obese patient is at higher risk than the nonobese patient. This section carefully presents clinical data addressing common issues during both the early and late postoperative periods for the obese surgical patient. The section on critical care is an honest appraisal of clinical care for the critically ill obese patient and common obesity-related management challenges in the intensive care setting. With emphasis on clinical studies, the information is unbiased, honest, and clearly presented to the reader.
The Special Situations section presents the implications for anesthetic management of the obese patient in the labor and delivery ward, pediatric anesthesia practice, and trauma care. As in the other sections, each topic is focused on relevant recent clinical studies without author bias endorsing one approach or technique over another. The authors avoid stating obvious and basic information, instead focusing on key concepts and observations made in cited references.
I strongly recommend this book for not only anesthesia providers but also departmental libraries. The information is certainly not as extensive as that provided by the major anesthesiology textbooks, but the focused review of current clinical information regarding the effect of obesity on organ function and anesthetic management makes this book invaluable. Congratulations to the authors and editors for producing this much-needed, high-quality text.
Brian P. McGlinch, M.D., Mayo Clinic, Rochester, Minnesota. mcglinch.brian@mayo.edu

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