Positioning the Bariatric Surgical Patient

An important part of every bariatric patient’s perioperative management is proper positioning. When placed in a non-physiologic position, the obese patient can experience significant cardiopulmonary dysfunction. A spontaneously breathing obese patient should never lie supine, whether before, during, or immediately after surgery. Tilting the operating room table to the reverse Trendelenburg position during induction of anesthesia increases the patient’s oxygen reserves, which results in a longer safe apnea period. This position also facilitates bag-mask assisted ventilation. Ramping the patient’s upper body and head improves the view during direct laryngoscopy resulting in greater success with tracheal intubation. Standard operating room tables are not safe for extremely obese patients, so special attention is important when moving the table or when changing patient position to avoid accidents. For any surgical position, all dependent pressure points must be adequately padded and the patient’s head, neck, and extremities supported to prevent perioperative neurologic and muscle injuries.