Obesity is a worldwide health problem affecting 34% of the American population. As a result, more patients requiring anesthesia\r\nfor thoracic surgery will be overweight or obese. Changes in static and dynamic respiratory mechanics, upper airway anatomy,\r\nas well as multiple preoperative comorbidities and altered drug metabolism, characterize obese patients and affect the anesthetic\r\nplan at multiple levels. During the preoperative evaluation, patients should be assessed to identify who is at risk for difficult\r\nventilation and intubation, and postoperative complications. The analgesia plan should be executed starting in the preoperative\r\narea, to increase the success of extubation at the end of the case and prevent reintubation. Intraoperative ventilatory settings should\r\nbe customized to the changes in respiratory mechanics for the specific patient and procedure, to minimize the risk of lung damage.\r\nSeveral non invasive ventilatory modalities are available to increase the success rate of extubation at the end of the case and to\r\nprevent reintubation. The goal of this review is to evaluate the physiological and anatomical changes associated with obesity and\r\nhow they affect the multiple components of the anesthetic management for thoracic procedures.
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