Update on anesthesia for patients undergoing post-bariatric body contouring surgical procedures

Individuals who have undergone bariatric surgery and have lost a considerable amount of weight tend to seek consultation with plastic surgeons for body contouring surgery. This growing population is overweight, and they still have some of the co-morbidities of obesity, such as hypertension, ischemic heart disease, pulmonary hypertension, sleep apnea, iron deficiency anemia, hyperglycemia, among other pathologies. They should be considered as high anesthetic risk and therefore, should be thoroughly evaluated. If more than one surgery is planned, a safe operative plan must be defined. The anesthetic management is adjusted to the physical condition of the patient, the anatomical and physiological changes, the psychological condition, as well as the surgical plan. Anemia is a frequent complication of obesity and bariatric procedures and should be compensated with appropriate anticipation. Pre-anesthetic medications may include benzodiazepines, alpha-2 agonists, anti-emetics, antibiotics, and pre-emptive analgesics. Regional anesthesia should be used whenever possible, especially subarachnoid blockade, since it has few side effects. General anesthesia should be left as the last option and can be combined with regional techniques. It is prudent to use conscious sedation for facial and neck surgery, maintaining strict control, especially with respect to the airway management. Thromboprophylaxis is mandatory and should continue for several days after the operation.