Optimisation du parcours de soins en chirurgie du patient obèse

Obesity is associated with comorbidities, such as sleep apnea syndrome (SAS), diabetes, hypertension, stroke and gastroesophageal reflux disease. Comorbidities convey a high risk of perioperative respiratory and cardiovascular complication such as: difficult control of the airways (intubation, mask ventilation) and post-extubation respiratory distress, secondary to atelectasis or airway obstruction, sometimes associated with the use of opioids. The clinical pathway of the surgical obese patient starts with the anesthetist consultation, centered on the preoperative screening and management of SAS, and on the postoperative rehabilitation program. During surgery, the perioperative use of continuous positive pressure, the use of airways control protocols, of protective ventilation, of hemodynamic optimization, opioid-sparing and semi-seated positioning reduce the incidence of complications. Close monitoring in the postoperative period is required, as well as the implementation of early rehabilitation after surgery, starting preoperatively. Preventive preoperative, and curative postoperative, non-invasive ventilation improves prognosis in high-risk patients.