Anesthetic Management of Patients with Obesity

Year 2016, Volume: 25 Issue: 3, 406 - 419, 30.09.2016

Öznur Uludağ Mediha Türktan

https://doi.org/10.17827/aktd.248423

Cited By: 1

Abstract

Obesity has become a rapidly growing public health problem in whole world. Obesity and alterations due to obesity which include changes in metabolic, cardiovascular and pulmonary functions increase risk of perioperative mortality and morbidity. Obesity impacts anesthesia procedures significantly. Comorbid diseases such as hypertension, coronary artery disease, diabetes mellitus, and pulmonary diseases increase risk of complications during anesthesia. In this review we evaluated important factors that should be considered during planning of anesthesia for obesity surgery and other surgeries, management of intraoperative anesthesia and postoperative analgesia, and management of complications.

Keywords

Obesity, anesthesia management

Obezite Hastalarında Anestezi Yönetimi

Abstract

Obezite, tüm dünyada giderek artan bir toplum sağlığı sorunu haline gelmiştir. Obezite ve obeziteye
bağlı ortaya çıkan metabolik, kardiyovasküler ve pulmoner fonksiyonlar üzerinde değişiklikler,
perioperatif mortalite ve morbidite riskini arttıran nedenlerdir. Obezite, anestezi uygulamalarını
önemli ölçüde etkilemektedir. Vücut ağırlığının artması ile birlikte hava yolu yönetiminin zorlaşması
başta olmak üzere hipertansiyon, koroner arter hastalıkları, diabetes mellitus, solunum yolu
hastalıkları gibi yandaş hastalıklar anestezi riskini artırmaktadır. Bu derlemede; anestezi pratiğinde
obezite cerrahisinde ve obezite dışı diğer cerrahilerde gün geçtikçe artan sayıda karşılaştığımız obez
hasta popülasyonunda preoperatif anestezi planlamasında dikkat edilmesi gereken hususlar,
intraoperatif anestezi yönetimi, postoperatif analjezi ve komplikasyonlar güncel bilgiler ışığında
sunulmuştur.

Keywords

Obezite, anestezi yönetimi

References

• Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological. Can J Anaesth. 2012;59:974-96.
• Obesity: preventing and managing the global epidemic: report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:1-253.
• Branca F, Nikogosian H, Lobstein T. The Challenge of obesity in the WHO European Region and the Strategies for Response. Denmark, WHO, 2007.
• T.C. Sağlık Bakanlığı. Türkiye Obezite ile Mücadele Programı 2010-2014. Ankara, T.C Sağlık Bakanlığı Temel Sağlık Hizmetleri Müdürlüğü, 2011.
• Juvin P, Lavaut E, Dupont H, Lefevre P, Demetriou M, Dumoulin JL et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595-600.
• Gonzalez H, Minville V, Delanoue K, Mazerolles M, Concina D, Fourcade O. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg. 2008;106:1132-6.
• Ogunnakie BO, Whitten CW Obesity and Anesthesia. In Clinical Anesthesia, 6th edition (Eds PG Barash, BF Cullen, RK Stoelting):755-68. Baltimore, Lippincott Williams & Wilkins, 2012.
• Levitan RM, Mechem CC, Ochroch EA, Shofer FS, Hollander JE. Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation. Ann Emerg Med. 2003;41:322-30.
• Martins AR, Nachbar RT, Gorjao R, Vinolo MA, Festuccia WT, Lambertucci RH et al. Mechanisms underlying skeletal muscle insülin resistance induced by fatty acids: importance of the mitochondrial function. Lipids Health Dis. 2012;11:30.
• Flynn C, Bakris GL. Interaction between adiponectin and aldosterone. Cardiorenal Med. 2011;1:96-101.
• Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D et al. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of The Obesity Society and the American Society of Hypertension. J Clin Hypertens (Greenwich). 2013;15:14-33.
• Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85:91-108.
• Arslan M, Turgut HC. Obezitedeki fizyolojik ve farmakolojik değişiklikler. Türkiye Klinikleri J Anest Reanim-Special Topics. 2015;8:1-10.
• Nashar K, Egan BE. Relationship between chronic kidney disease and metabolic syndrome: current perspectives. Diabetes Metab Syndr Obes. 2014;7:421-43.
• Morrish GA, Pai MP, Green B. The effects of obesity on drug pharmacokinetics in humans. Expert Opin Drug Metab Toxicol. 2011;7:697-706.
• Atak F, Işık B. Obez hastalarda genel anestezi. Turkiye Klinikleri J Anest Reanim-Special Topics. 2015;8:18-23.
• Sarandan M, Guragata-Balasa C, Papurica M, Duta C, Hordovan E, Rus C et al. Anesthesia in laparacopik bariatric surgery (gastric sleeve): preliminary experience. Timisoara Medical Journal. 2011;61:26-31.
• American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed. Darien, IL, American Academy of Sleep Medicine, 2014.
• Kaw R, Hernandez AV, Walker E, Aboussouan L, Mokhlesi B. Determinants of hypercapnia in obese patients with obstructive sleep apnea: a systematic review and metaanalysis of cohort studies. Chest. 2009;136:787-96.
• Mokhlesi B, Tulaimat A, Faibussowitsch I, Wang Y, Evans AT. Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. Sleep Breath. 2007;11:117- 24.
• Horvei LD, Braekkan SK, Mathiesen EB, Njolstad I, Wilsgaard T, Hansen JB. Obesity measures and risk of venous thromboembolism and myocardial infarction. Eur J Epidemiol. 2014;29:821-30.
• Scholten DJ, Hoedema RM, Scholten SE. A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery. Obes Surg. 2002;12:19-24.
• Domi R, Laho H. Anesthetic challenges in the obese patient. J Anesth. 2012;26:758-65.
• Jayaraman L, Sinha A, Punhani D. A comparative study to evaluate the effect of intranasal dexmedetomidine versus oral alprazolam as a premedication agent in morbidly obese patients undergoing bariatric surgery. J Anaesthesiol Clin Pharmacol. 2013;29:179.
• Wadhwa A, Singh PM, Sinha AC. Airway management in patients with morbid obesity. Int Anesthesiol Clin. 2013;51:26-40.
• Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251-70.
• Lemmens HJ. Perioperative pharmacology in morbid obesity. Curr Opin Anaesthesiol. 2010;23:485-91.
• Aldenkortt M, Lysakowski C, Elia N, Brochard L, Tramèr MR. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis. Br J Anaesth. 2012;109:493-502.
• Rebibo L, Dhahri A, Badaoui R, Dupont H, Regimbeau JM. Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis. 2015;11:335-42.
• Pelosi P, Gregoretti C. Perioperative management of obese patients. Best Pract Res Clin Anaesthesiol. 2010;24:2112-25.
• Cadi P, Guenoun T, Journois D, Chevallier JM, Diehl JL, Safran D. Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume-controlled ventilation. Br J Anaesth. 2008;100:709-16.
• Hans GA, Prégaldien AA, Kaba A, Sottiaux TM, DeRoover A, Lamy ML et al Pressurecontrolled ventilation does not improve gas exchange in morbidly obese patients undergoing abdominal surgery. Obes Surg. 2008;18:71-6.
• Ezri T, Muzikant G, Medalion B, et al. Anesthesia for restrictive bariatric surgery (gastric bypass not included): Laparoscopic vs open procedures. Int J Obes. 2004;28:1157-62.
• Almarakbi WA, Fawzi HM, Alhashemi JA. Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients. Br J Anaesth. 2009;102:862-8.
• Gaszynski T, Szewczyk T, Gaszynski W. Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia. Br J Anaesth. 2012;108:236-9.
• Zeidan A, Al-Temyatt S, Mowafi H, Ghattas T. Gender-related difference in postoperative pain after laparoscopic Roux-En-Y gastric bypass in morbidly obese patients. Obes Surg. 2013;23:1880-4.
• Clincksales CP, Greenfield MLVH, Vanarase M, Polley LS. An observational study of the relationship between lumbar epidural space depth and body mass index in Michigan parturients. Int J Obstet Anesth. 2007;16:323-7.
• Bamgbade OA, Khalaf WM, Ajai O, Sharma R, Chidambaram V, Madhavanc V. Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study. Int J Obstet Anesth. 2009;18:221-5.
• Cotter JT, Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass RA et al. Increased body mass index and ASA physical status iv are risk factors for block failure in ambulatory surgery: an analysis of 9,342 blocks. Can J Anaesth. 2004;51:810-6.
• Sahin T, Balaban O, Sahin L, Solak M, Toker K. A randomized controlled trial of preinsertion ultrasound guidance for spinal anaesthesia in pregnancy: outcomes among obese and lean parturients. ultrasound for spinal anesthesia in pregnancy. J Anesth. 2014;28:413-9.
• Saranteas T. Limitations in ultrasound imaging techniques in anesthesia: obesity and muscle atrophy? Anesth Analg. 2009;109:993-4.
• Klasen J, Junger A, Hartmann B, et al. Increased body mass index and peri-operative risk in patients undergoing non-cardiac surgery. Obes Surg. 2004;14:275-81.
• Lewandowski K, Lewandowski M. Intensive care in the obese. Best Pract Res Clin Anaesthesiol. 2011;25:95-108.
• White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F, Fast-Track Surgery Study Group. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg. 2007;104:1380-96.
• Karlsson A, Wendel K, Polits S, Gislason H, Hedenbro JL. Preoperative nutrition and postoperative
• discomfort in an eras setting: a randomized study in gastric bypass surgery. Obes Surg. 2015;25:1-6.
• Awad S, Carter S, Purkayastha S, Hakky S, Moorthy K, Cousins J et al. Enhanced Recovery After
• Bariatric Surgery (ERABS): clinical outcomes from a tertiary referral bariatric centre. Obes Surg. 2014;24:753-8.
• Correspondence Address / Yazışma Adresi Öznur Uludağ
• Adıyaman Üniversitesi Tıp Fakültesi,
• Anesteziyoloji ve Reanimasyon Anabilim Dalı, Adıyaman, Turkey
• e-posta: [e-mail]
• Geliş tarihi/ Received: 10.02.2016
• Kabul tarihi/Accepted: 07.03.2016