Perioperative risk factors in obese patients for bariatric surgery: a Singapore experience

Iyer US, Koh KF, Chia NCH, Macachor J, Cheng A
Correspondence: Dr Uma Shridhar Iyer, uma_shridhar@rediffmail.com

ABSTRACT
Introduction Morbid obesity and obstructive sleep apnoea (OSA) are increasingly encountered in anaesthetic practice today. Difficult intubation may be seen more frequently in our practice. This high-risk group may also be more prone to complications in the postoperative period.
Methods We reviewed a consecutive series of patients who had undergone laparoscopic gastric banding at our institution from 2001 to 2006. The incidence of difficult intubation, early postoperative complications and its attendant risk factors were studied.
Results Severe OSA and neck circumference greater than 44 cm were factors associated with difficult intubation in morbidly obese patients who presented for bariatric surgery. Asthma and increasing age may be associated risk factors for adverse events in the postoperative period.
Conclusion It is important to anticipate and prepare for a difficult intubation scenario in patients with severe OSA and a larger neck circumference. Close monitoring is recommended for patients with respiratory comorbidities and advanced age.

Keywords: bariatric surgery, difficult postoperative complications, morbid obesity, obstructive intubation, sleep apnoea
Singapore Med J 2011; 52(2): 94-99