Key Points

• Obesity is a now very common condition encountered in UK and can be associated with significant comorbidities with direct impact on our practice.
• Bariatric surgery is effective and safe with benefits of regression of associated comorbidities and improvement on quality of life.
• The perioperative care for bariatric surgery is provided by a multidisciplinary team of surgeons, anaesthetists, dieticians, physicians, physiotherapists, psychologists and nurses.
• As anaesthetists, we bring not only our practical skills of intravenous access, airway management, safe transfers, pain management and treatment of the unwell patient to the table, we are also key players in preoperative assessment and optimisation, elements that are essential to making a full postoperative recovery.

Since the King’s Fund publication ‘No decision about me, without me’, improving shared decision making has become a national priority (Coulter and Collins, 2011; Ross et al, 2018). One survey of 500 doctors found 82% admitted to prescribing treatments they consider unnecessary (Academy of Medical Royal Colleges, 2016), whilst over 30% of patients wish to have more involvement in decisions about their care (NHS England, 2018). The Montgomery ruling means there is now a legal imperative to discuss 'material risks' with patients. However, what really is ‘shared decision-making’ (or ‘SDM’ as it is commonly known)? Is it worth it? And don't we already do it?

Surgical resection remains central to the management of many cancers. Nonetheless, even the most vigilant surgical technique may leave residual malignancy and promote tumour cell shedding into the blood and lymphatics. The propensity of these residual cells to thrive is determined by a complex interplay between the intrinsic ability of the cells to proliferate and invade, the microenvironment serving those cells and the patient’s ability to mount an anti-cancer response. While the intrinsic make-up of residual cells is not modifiable, there is growing interest in the ability of anaesthetic drugs to directly affect the cancer.

Definitions for chronic pain in published studies include: continuous or recurrent pain persisting beyond expected normal healing time [5], self-reported “chronic pain”, pain lasting greater than 1 month, greater than 3 months, greater than 6 months, greater than 1 year, and pain present on more than 15 days a month [1]. Guidelines from the American Society of Anesthesiologists define chronic pain as pain of any etiology not directly related to neoplastic involvement, associated with a chronic medical condition or extending in duration beyond the expected temporal boundary of tissue injury and normal healing, and adversely affecting the function or well-being of the individual [6].

In recent years there has been explosion in the use of noncardiac implantable electronic medical devices with various indications pouring in from the new research. As an anaesthetist, we are very likely to encounter patients with these devices. Not only coming through our theatre doors but also in other areas like radiology, endoscopy suite and intensive care. In the absence of anaesthetic guidelines for non-cardiac electronic medical devices, anaesthetists should ensure risk reduction strategies to enhance patient safety. This article will describe the various non-cardiac devices available and their vulnerability to various environments.