Anaesthesia for the Overweight and Obese Patient
Anaesthesia for the Overweight and Obese Patient. M. Bellamy and M. Struys. Published by Oxford University Press, Oxford, UK. Pp. 108 . Price £5.99. ISBN 978-0-19-923395-3.This publication is the second in a series of ‘practical pocketbooks’ from Oxford University Press. As the authors state in their introduction, obesity is becoming increasingly prevalent among the general population of the western world. This is not a book focusing on anaesthetizing patients for specialized bariatric surgery, but rather it targets the general anaesthetist who is faced with providing elective and emergency care across a range of surgical specialties for patients in whom obesity is an increasingly common co-morbidity.
In terms of structure, the book is divided into 11 chapters. Each chapter begins with a brief list of summary key points, followed by eight to 10 pages of text. The chapters are consistent in terms of style, delivery, and level of knowledge. At the end of each chapter is a list of suggested reading. The reading lists are by no means comprehensive but are focused and reasonably up to date. The authors admit that the published literature on this specialized area is increasing at such a rate that it would be nigh impossible for any reading list to be entirely up to date. The different areas covered by each chapter follow a sensible and logical approach to the problems of obesity.
The first two chapters look at the definitions of obesity, its epidemiology, and attempt to explain the underlying physiological and molecular mechanisms. The next two chapters focus on the abnormal physiology associated with obesity and the consequent co-morbidity. Quite rightly these chapters lay an emphasis on respiratory, cardiovascular, and diabetic issues. Sleep apnoea and the obesity hypoventilation syndrome are considered in the fifth chapter. Chapter 6 covers anaesthetic pharmacology in obesity. The next four chapters deal with the more practical aspects of patient care: preoperative assessment, intraoperative and airway management, and finally recovery and postoperative analgesia. These four chapters contain a large number of useful and valuable comments and suggestions, quite clearly based on the extensive experience of the two authors. The final chapter looks briefly at the specialized area of bariatic surgery itself.
Does this book succeed in achieving its stated aim? Almost certainly, yes. Super-obese patients may well undergo their weight reducing surgery in specialized areas, cared for by highly experienced teams. For all those other anaesthetists, be it general, obstetric, trauma or neuro-anaesthetist, this book will definitely be a very useful tool. It will be particularly useful for those anaesthetists involved specifically with the preoperative assessment process in terms of highlighting particular problems and helping to set up local guidelines and protocols. Despite its limitations in terms of size, and having just more than 100 pages, the authors have to be commended for the amount of information that they managed to contain within its pages. At the same time, this aspect gives rise to the only criticism I have of this book. Perhaps because of its layout, or the concentrated information, it does not feel like a book that the reader can easily or quickly dip in and out of. The emergency anaesthetist faced with an obesity-related problem needing an urgent solution may have difficulty in finding a quick answer.
This criticism aside I would highly recommend this book, both for anaesthetists about to take on bariatric work but equally all anaesthetists across all specialties.
Sheffield, UK E-mail: Damian.Doyle{at}sth.nhs.uk
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