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Background: According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery. The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia. To approach these ideal conditions, a Total Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed., Methods: 10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study. TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases. Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated., Results: The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency., Conclusions: TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients.

In order to evaluate the short- and long-term complications of obesity surgery, a review was done on 452 cases of morbidly obese patients who met the basic guidelines for obesity surgery and were operated upon; gastric bypass was performed in all of them. There were seven major complications: one myocardial infarction, two pulmonary embolisms, two gastric fistulas, one sepals from bowel infection and one acute thrombocytopenia purpura. Five of the patients died. It is important to note, in those patients with abdominal complications, the absence of classical signs and symptoms of peritonitis, and the need to act immediately in order to solve the postoperative problem. As in other series, minor complications were also present: subcutaneous infection in 18 cases, hernia in four, peptic syndrome in three, mild anemia in 28 and hypovitaminosis A and B in 58; all received medical treatment without problem. It is concluded that obesity surgery, like all major surgery in high-risk patients, may have complications, and therefore It is necessary to recognize them in order to prevent them, and if they emerge, diagnose and treat properly.

Reluctance or open opposition to new surgical techniques or surgical approaches are common both with medical and non-medical groups, and they are mainly due to lack of proper knowledge of the possibilities and limitations of these procedures. In Mexico, there is a lag between medical and surgical progress and the medical and lay information about them. The purpose of this study was to assess the magnitude of this situation. The 238 physicians interviewed comprised 137 internists and 101 surgeons. 787 patients were also interviewed; all of them were asked about obesity surgery, information on medical and non-medical publications, advice about obesity surgery In a special case or patient, and type of surgery performed. Among the physicians, none of the internists would advise obesity surgery to any patient, and most of them only recall intestinal bypass as the current procedure for obesity; only 3% had read about obesity surgery. Surgeons, on the contrary, had more precise information about surgery, 25% had read about techniques and results, and 20% would advise surgery for their patients. The general population had a very vague idea of obesity surgery, with confusion between liposuction and intestinal surgery; most of the individuals interviewed had magic or miraculous conceptions about surgeons and their powers' to eliminate fat. It is concluded that medical and non-medical groups lack the adequate knowledge and comprehension of obesity surgical procedures, and this is one of the problems obesity surgeons face in everyday practice.

A simple auto-evaluation sheet is presented for the proper assessment of the patient's condition after surgery. Stress is put not only on the weight loss, but on other important factors as well.