General anaesthesia techniques

The obese patient should be sited on the operating table before the induction of anaesthesia. Rapid sequence induction is required:

• intravenous induction agent given, e.g. thiopentone
• neuromuscular blocker given with simultaneous cricoid pressure to prevent aspiration
• intubation and intermittent positive pressure ventilation
• the inspired oxygen concentration may need to be augmented in order to maintain adequate oxygenation
• short-acting opiates, e.g. fentanyl, may be better than those with an increased risk of postoperative respiratory depression

Monitoring peroperatively is with:

• intra-arterial blood pressure line: cuff readings are unreliable
• ECG
• oxygen saturation monitor
• capnography
• frequent arterial blood gas sampling

If the patient has cardiorespiratory compromise, central venous lines may be considered. One must ensure that the neuromuscular blockade has been properly reversed at the end of anaesthesia. Extubate only when the patient is capable of maintaining their own airway.