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Obesity has become endemic, even in children. Systemic complications associated with obesity include metabolic syndrome, cardiovascular disease, and respiratory compromise. These comorbidities require adequate investigation, targeted optimisation, and, if surgery is required, specific management during the peri-operative period. Specific peri-operative strategies should be used for paediatric patients who are overweight or obese to prevent postoperative complications, and optimising the respiratory function during surgery is particularly crucial. This Review aims to provide up-to-date information on peri-operative management for physicians who are caring for children and adolescents (usually younger than 18 years) who are overweight or obese undergoing surgery, including bariatric surgery. We have particularly focussed on the physiological consequences of obesity-namely, obstructive sleep apnoea, respiratory compromise, and pharmacological considerations.

Posterior urethral valves (PUVs) in patients with Down syndrome (DS) have been previously described. However, no case of PUVs has been reported in an adult patient with DS. We report on a 40-year-old man with DS, who presented with two severe urinary infections and obstructive symptoms. He was found to have type 3 PUVs associated with bladder neck sclerosis. PUV resection and bladder neck incision were done. Because PUVs seem to be more frequent in patients with DS, complete investigations should be performed, even in adults with DS, in the case of urinary infection or lower urinary tract symptoms.

The growing importance of ambulatory surgery during the past decade has led to the development of efficient anesthetic techniques in terms of quality and safety of anesthesia and recovery. In these challenging objectives, intravenous techniques have played an important role, as they provide safe, efficient, and cost-effective anesthesia in the ambulatory setting. Among the numerous intravenous drugs, propofol, with its fast and smooth onset of action, short duration of action, and low incidence of postoperative side effects appears to be the anesthetic of choice in this situation. The recent development of new techniques of administration (such as TCI, monitored anesthesia care, or patient-controlled sedation) and monitoring (such as the BIS and the availability of "hit and run" drugs such as remifentanil) will optimize intraoperative conditions and recovery, thus allowing faster home readiness in the ambulatory setting.

Drug dosing schemes of anaesthetic agents in elderly patients are often a challenge for the clinician, and neuromuscular blocking agents (NMBA) are no exception to this rule. Only a good insight in the pharmacokinetic and pharmacodynamic changes in the elderly may allow a rational use of these agents in elderly patients.