Preface -- OAL Anaesthesia for the Overweight and Obese Patient

Introduction

Further Reading

Introduction

Obesity is a major health care challenge for the Western world. It has been a problem in the United States for many years. Healthcare trends in Western Europe tend to follow those in the United States, around 10 years later. The World Health Organisation recently reported that both childhood and adult obesity have increased dramatically in prevalence in Western Europe in recent years. Childhood obesity is now 10 times more common than it was in 1970.

In the adult population, 50% are overweight, and one third are obese. This has huge implications for health care costs as well as for the economy at large. In the Western Europe, 6% of health care expenditure is attributable to obesity, and this figure is set to rise dramatically.

Morbidly obese patients suffer numerous comorbidities. This presents a huge challenge to the anaesthetist. While raised BMI is not of itself a predictor of poor postoperative outcome, obesity related comorbidity is a strong predictor, and is very common. Moreover, the morbidly obese and super obese patient poses considerable technical challenges to the anaesthetist. Over 50% of critical incidents reported in anaesthesia involve obesity as a contributory factor.

This book is aimed at the general anaesthetist who is likely to encounter increasingly large numbers of morbidly obese and super obese patients in his everyday practice over the next few years. Morbidly obese patients present for elective surgery for unrelated conditions, for procedures related to obesity (including joint replacement or bariatric surgery) and for procedures related to their comorbidity (for example, vascular disease secondary to diabetes). In this book, we have aimed to outline the basics of obesity physiology and pathology, in the hope that this will give the anaesthetist and necessary building blocks with which to solve complex clinical problems. Additionally, we have given a number of practical hints and suggestions, based on our experience of anaesthesia for morbidly obese and super obese patients. While this experience has largely been derived from bariatric surgical practice, much of it is generalisable to other operative situations where morbidly obese patients are encountered.

Each chapter is followed by a further reading section, rather than an exhaustive reference list. The literature on obesity surgery, obesity comorbidities and anaesthesia for the obese is enlarging on an almost daily basis. While we have made every effort to ensure the text is based on the latest knowledge, the field is advancing so rapidly that we strongly recommend the interested reader to use this book as a starting point, and not as a definitive guide.

The authors are extremely grateful to those colleagues who have contributed to our clinical experience, and to those who have made helpful suggestions on the manuscript of this book. In particular, we are grateful to Professor Chris Dodds, director of the South Tees sleep laboratory, and to Mr Stephen Pollard, obesity surgeon, Leeds.

Mark C. Bellamy, Leeds, UK

Michel M.R.F. Struys, Ghent, Belgium

February 2007.