The obese patient poses special problems when presenting for anesthesia and surgery. A consideration of anesthetic problems related to obesity brings to mind those in several areas: (1) problems related to intravenous therapy; (2) problems referable to securing and maintaining the airway; (3) ventilatory problems, both intraoperatively and postoperatively; (4) difficulty in attaining adequate relaxation and adequate operative conditions; (5) factors influencing the uptake and distribution of anesthetic agents; and (6) anatomic problems encountered with regional anesthesia. In addition (7) frequent accompaniments and sequelae of obesity, eg, hypertension and diabetes mellitus, may alter responses to anesthetic agents and other depressant drugs.
Our approach to anesthetic management of the obese patient is necessarily pragmatic, because definitive studies assessing the risks of obesity are lacking. We believe that obese patients have a greater incidence of anesthetic complications; further studies need to be made.
Merely starting an intravenous solution may be unnerving to
Willis A. Warner, Larry P. Garrett. The Obese Patient and Anesthesia. JAMA. 1968;205(2):102–103. doi:10.1001/jama.1968.03140280056014