Department of Anesthesiology & Critical Care, University of Pennsylvania, School of Medicine, Philadelphia, PA 19146 Globally, obesity has surpassed malnourishment as a health problem. As patients presenting for bariatric surgery procedures get heavier, older and sicker, their anesthetic care gets more involved. The average patient presenting at the Hospital of the University of Pennsylvania has a BMI of 51. In these patients, preoperatively, issues of hypertension, diabetes and hyperlipidemia are compounded by pulmonary issues like sleep apnea. Their hypersensitivity to volatile agents makes them prone to more adverse respiratory events later.