Seventeen years passed from the time when Professor Ken Fearon and Professor Olle Ljungqvist met in London at a nutrition symposia and decided to follow the Professor Henrik Kehlet’s concept of multimodal surgical care. By this time the ERAS^® (Enhanced Recovery After Surgery) Study Group comprised of leading surgical groups was changed to the ERAS Society that engaged anaesthetists, nurses, dieticians and physiotherapists. Thus, anaesthesia became an important element of peri-operative strategy which result in expedite recovery after surgery. The increasing number of bariatric surgical procedures created the need of consensus regarding optimal perioperative care in bariatric surgery. According ERAS Society Guidelines anaesthetic management contains treatment during pre-, intra- and postoperative period (1).

Preoperative assessment by anaesthesiologist is belived to be a basic element of anaesthetic care. Psychological and pharmacological preparation of the patient called premedication is strongly recommended, as it reduces stress and anxiety and improve of compliance. It has been shown that the history of tobacco smoking and alcohol cessation is associated with increased risk of postoperative morbidity and mortality. Tobacco smoking should be stopped at least 4 weeks before surgery. When history of alcohol abuse is present, at least 2 years of abstinence should be strictly adhered. The large study reported that consumption of more than 2 alcohol equivalents per day within 2 weeks of surgery was an independent predictor of pneumonia, sepsis, wound infection and length of hospital stay. Preoperative fasting does not differ from other patients. Obese patients may have clear fluids up to 2 h and solids up to 6 h prior to induction of anaesthesia (2). There is a strong recommendation to use glucocorticoids as anti-inflammatory and antiemetic medication. It has been shown that a dose from 2.5 to 5.0 mg dexamethasone given 90 min prior to induction of anaesthesia is necessary to achieve the effect on postoperative nausea and vomiting (PONV) (3). According to the guidelines 8 mg dexamethasone should by administered 90 minutes before the induction of anaesthesia in obese patients. Because of glucocorticoid-induced hyperglycaemia it is recommended to monitor blood glucose level intra- and postoperatively in patients undergoing bariatric surgery (1). There is a strong recommendation to use carbohydrate loading with iso-osmolar drinks 2-3 h before induction of anaesthesia in obese, non-diabetic patients. However, there is not enough evidence about clinical benefits and disadvantages of carbohydrate conditioning in morbidly obese and in patients with gastroesophageal reflux who are at risk of aspiration during anaesthetic induction (1).