response relationships. Fondaparinux is a synthetic polysaccharide, which binds to antithrombin, thereby indirectly inhibiting factor Xa. The administration of enoxaparin, in various dosing regimens, is also safe for thromboprophylaxis in morbidly obese patients undergoing bariatric/ laparoscopic surgery.
Combination of medical management, early ambulation, and external compression devices adequately prevented the development of VTE in patients.
AIRWAY EVALUATION IN OBESE PATIENTS Obesity is often related with a difficult intubation. This difficult intubation is thought to result from these obese patients having a short thick neck, relatively large tongue, and significant reduction in the soft tissue space. Other factors that have been associated with difficult laryngoscopy include short sternomental distance; short thyromental distance; large neck circumference; limited head, neck, and jaw movement; receding mandible; and prominent teeth. Of these factors, the most significant was the large neck circumference. A study conducted in 2004 studied the impact of positioning for tracheal intubation. They compared the sniffing position that is placing a cushion under the head and raising the occiput versus the ramped position where the entire upper body is elevated such that the external auditory meatus and sternum are in a straight line. They found the ramped position created better intubating conditions. With the advent of newer devices for tracheal intubation like video laryngoscopes it has eased the burden of a difficult intubation though not abolished it. The recent videolaryngoscopes like Glidescope, Mc Grath, Storz C-Mac have redefined Cormach and Lehane scores. Fibre optic bronchoscopy still remains the gold standard and one must acquire the required skill set.
PHARMACOKINETICS OF DRUGS Most anesthetic drugs are administered based on their ideal body weight (ILW), their lean body weight (LBW) or their total body weight (TBW), therefore one should be familiar with these terms and their measurements. IBW can be measured by the following formula IBW=22 X H2
(H is height in metre2 ).
Normal weight ranges between ± 10% of IBW. LBW is TBW minus weight of body fat. Body fat is adipose tissue, while TBW is bones, muscles, tendons, ligaments and body water. LBW is approximately 80%
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