The prevalence of obesity is increasing. Morbidly obese patients figure frequently in peri-operative morbidity and mortality reports. Morbidly obese patients present a significant challenge to the anaesthetist. This is in part due to technical challenges, in part due to co-morbidities, and in part to physiological changes consequent on morbid obesity. An understanding of these changes is important for safe anaesthesia in this patient group. Careful pre-operative assessment and evaluation can bring many co-morbidities to light, and allows appropriate preparation of the patient, theatre and care team prior to surgery. Cardiorespiratory problems, reflux and diabetes are common. The high incidence of obstructive sleep apnoea necessitates postoperative intensive or high dependency care in all cases. This research work highlights the management of the morbidly obese patient, preoperatively, intraoperatively, and postoperatively regarding all aspects.