OBESITY AND BARIATRICS: ANESTHETIC STRATEGIES TO AVOID RESPIRATORY FAILURE

Abstract

Introduction: Obesity has been characterized as a multifactorial chronic condition associated with metabolic, inflammatory, and mechanical alterations that directly impact respiratory function. In the context of bariatric surgery, obese patients have been observed to present reduced pulmonary compliance, increased respiratory effort, and a greater propensity for hypoventilation and atelectasis. Objective: To analyze the main anesthetic strategies used in obese patients undergoing bariatric surgery, focusing on the prevention of respiratory failure in the perioperative period. Methodology: This was a literature review conducted according to the PRISMA checklist recommendations, using the PubMed, SciELO, and Web of Science databases. Articles published in the last 10 years were selected. The descriptors used were "obesity," "bariatric surgery," "anesthesia," "respiratory failure," and "ventilatory strategies." Inclusion criteria included clinical studies with obese patients, available full publications, and research addressing anesthetic management in bariatric surgery. Exclusion criteria included duplicate studies, articles with non-human samples, and studies that did not directly address respiratory outcomes. Results: The findings showed that protective mechanical ventilation with low tidal volumes and adequate PEEP reduced pulmonary complications. Optimized pre-oxygenation and proper positioning, such as the ramp position, showed improved oxygenation. The judicious use of opioids and the preference for multimodal analgesia techniques contributed to less respiratory depression. Furthermore, early extubation associated with non-invasive ventilatory support demonstrated effectiveness in preventing respiratory failure. Conclusion: It was concluded that the adoption of individualized anesthetic strategies was fundamental to reducing the risk of respiratory failure in obese patients undergoing bariatric surgery, highlighting the importance of protective ventilation, adequate airway management, and continuous monitoring as essential pillars for better clinical outcomes.