Perioperative management of hemorrhagic stroke in morbidly obese patients: A narrative review.

Background: Intracerebral hemorrhage (ICH) constitutes approximately 10-15% of all strokes and is a major contributor to long-term neurological morbidity and mortality. Morbid obesity (body mass index ≥40 kg/m Methods: This narrative review critically explores perioperative anesthetic strategies in adult patients presenting with ICH and morbid obesity. A systematic appraisal of peer-reviewed literature from the past decade was conducted using PubMed, Scopus, and Google Scholar. The review emphasizes preoperative, intraoperative, and postoperative management considerations within the integrated context of neuroanesthesia and obesity-related physiology. Results: Key recommendations include the use of the STOP-BANG screening tool for obstructive sleep apnea (OSA), dosing of anesthetic agents based on ideal or lean body weight, lung-protective ventilation with low tidal volumes and individualized positive end-expiratory pressure settings, and meticulous control of blood pressure and intracranial pressure. Postoperatively, the application of non-invasive ventilation, opioid-sparing multimodal analgesia, hypocaloric high-protein enteral nutrition, and mechanical thromboprophylaxis has shown improved clinical outcomes. Conclusion: Effective perioperative management of ICH in morbidly obese patients necessitates a multidisciplinary and patient-specific approach. Incorporating neuroanesthetic principles, pharmacokinetic adjustments, and comprehensive organ monitoring is essential for minimizing complications and optimizing neurological recovery.