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Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion., (© 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.)

Summary: We retrospectively reviewed the anaesthetic charts of patients who had undergone bariatric surgery in our regional centre since the start of the service. We identified Cormack and Lehane grade of laryngoscopy, any difficulties associated with tracheal intubation, and the impact of age, gender and body mass index on laryngoscopy grade. The patients were anaesthetised in the in the 'beach chair' position prior to laryngoscopy. One hundred and ninety-two patients' notes were available for review out of a total of 198. Mean age was 43.3 years (SD 10.3) and mean BMI 50.8 (SD 8.0). Grade of laryngoscopy was unrecorded in 20 patients. Of the 192 patients, 162 (84%) had a Cormack and Lehane grade of 1 or 2. Nine (4.7%) patients were graded as 3 and only one patient had a grade 4 laryngoscopy. There were two cases (1%) of difficulty in intubation. A bougie was used 16 times (8%). Logistic regression showed that age was a significant factor for increasing laryngoscopy grade (p = 0.0102) but that BMI was not (p = 0.6271).