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Medical records should include the patient’s weight and body mass index (BMI).²⁵⁸

Ideally, patients with morbid obesity should undergo preassessment by a senior anaesthetist.²⁵⁸

Advanced warning of elective patients with morbid obesity should be given to the appropriate ward/ theatre environment by the preoperative assessment team. Additional specialised equipment is necessary and should be available for every patient with morbid obesity at all stages of the perioperative pathway.²⁵⁸

Patients undergoing bariatric surgery should be considered for level 2 or 3 critical care postoperatively.²²

Patient dignity should be maintained preoperatively by ensuring appropriate theatre clothing is available in the day case suite or admissions area.

The safe movement and positioning of patients with obesity may require additional staff and specialised equipment.^259,260 An operating table, hoists, beds, positioning aids (including for induction of anaesthesia) and transfer equipment appropriate for the care of patients with obesity should be available in appropriate quantities for the caseload, and staff should be trained in its use.^258...

Operating lists should include the patients’ weight and BMI to highlight additional or alternative equipment requirements. Equipment and manual handling issues should be highlighted at the team brief element of the WHO Surgical safety checklist.^4,258

In view of the increased technical and clinical risks posed by patient with morbid obesity, senior anaesthetic and surgical staff should manage these patients.²⁶²

In the postoperative period, the safety of patients with obesity may be improved by the use of supplemental oxygen, non-invasive ventilation (continuous positive airway pressure), monitoring of sedation, and ideally continuous pulse oximetry.²⁶³

Patients with obstructive sleep apnoea have a higher incidence of postoperative complications including hypoxia, renal failure, unplanned critical care stay, and delayed discharge. Therefore, consideration should be given to monitoring such patients in a critical care environment postoperatively.²⁶⁴