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Aparna Sinha, Lakshmi Jayaraman, Dinesh Punhani, editors.
“Morbid Obesity: Anesthesia and Perioperative Management”.
2016. First. Byword Books Pvt. Limited: New Delhi.
Anesthetizing the morbidly obese patient can be a daunting task for the anesthesia trainee or the seasoned anesthesiologist. As a large population across our country marches toward an obesity epidemic, and the world moves onto a super morbid obese pandemic, it becomes pertinent that we update ourselves with the requisite knowledge and skills needed for safe perioperative care of morbidly obese. The first edition of “MORBID OBESITY: ANESTHESIA AND PERIOPERATIVE MANAGEMENT” has been compiled comprehensively by Dr. Aparna Sinha aptly supported by Dr. Lakshmi Jayaraman, Dr. Dinesh Punhani et al. who all are stalwarts and champions of safe anesthesia delivery.
Indeed, the editors have collated their enormous cumulative experience into this book in a simple, lucid manner, with pearls of wisdom highlighted aptly, making it an engaging read.
The book begins with a chapter on “Evaluation, Prehabilitation and Enhanced recovery after surgery (ERAS),” which is the foundation and pillar of optimal anesthesia outcome, especially when facilitating the concept of ERAS for the morbidly obese. This chapter befittingly focuses on identifying and optimizing a host of varied comorbidities that besiege a morbidly obese patient, thereby preempting perioperative complications and preventing adverse outcomes. The clinical pathway of ERAS has been logically interwoven with the concept of comprehensive evaluation and prehabilitation. Chapters on changing perspectives in anesthesia and anesthetic considerations apprise the reader of all aspects of the systems-based approach to perioperative anesthetic care including the principles of pharmacokinetics and fluid management in this special group of patients. Overriding omnipresent concerns of airway-related issues are aptly addressed in two comprehensive chapters on airway management and extubation strategies. The highlights of these chapters have been well laid out in the form of self-descriptive images and boxed salient points. The crucial elements of patient preparation and positioning, availability of experienced personnel, airway cart with rescue devices, and formulation of strategies and backup plans both during induction and emergence have been addressed. The next chapter on postoperative pain management stresses on multimodal opioid-sparing techniques especially on the emerging role of ultrasound-guided regional anesthesia techniques. As clinical deterioration occurs rapidly in morbidly obese, the subsequent chapter dwells on the physiological basis, early identification, preventive strategies, and treatment of perioperative complications. The challenges of obstructive sleep apnea and sleep disordered breathing disorders, ranging from pathophysiological changes, risk assessment and reduction and anesthetic implications for entire perioperative management have been thoroughly addressed with great attention to all specific details thereby ensuring easier implementation and safer outcomes. The challenges of morbid obesity to day care procedures and pregnancy have also been dealt with comprehensively. The addition of chapters on bariatric surgical options, imaging challenges, nutritional aspects, and appendices on bariatric setup, references to weight and dosages have indeed ensured comprehensiveness to this valuable book.
The book encompasses detailed relevant scientific basis of practice and clear, concise management approaches. Clinical pathways and protocols have been suggested based on peer-reviewed scientific literature in almost all areas of perioperative management of morbidly obese patients.
This book is systematically organized with self-explanatory illustrations, glossy photographs, and boxed salient highlights. Chapters have a contemporary eloquent approach and contain a wealth of practical scientific information which is vital to all anesthesiologists working in varying clinical settings. I would recommend this book to all postgraduate students who need to understand the pathophysiological basis of perioperative care, to an amateur for safe set up of bariatric anesthesia practice and also to an academician for the vast evidence of clinical pathways and protocols ensuring optimal and better patient outcomes in this highly specialized skillful art and science of caring for morbidly obese.
I wish all readers of this book, a comforting reading, and an equally smooth, safe, and excellent care of the morbidly obese.