Suprakondiler femur kırığı ile birlikte olan morbid obez hastada anestezi yönetimi

Year 2009, Volume: 15 Issue: 1, 67 - 70, 01.02.2009

Ayşe Mızrak Mustafa Işık Senem Koruk Rauf Gül Süleyman Ganidağlı Halit Demir Ünsal Öner

Abstract

To our literature search, supracondylar femur fracture is not a rare circumstance with morbid obesity. We report a case of closed reduction and internal fixation for a supracondylar femur fracture of a 46-year-old, 168 kg, 172 cm tall [body mass index-(BMI) > 55 kg/m ] morbid obese man. The patient was premedicated with diazepam 10 mg orally and was brought to the operating room on a transport stretcher and taken onto conventional operating tables hardly that had been placed side by side. Since the morbidly obese patient has such risk factors as hypertension and Mallampati Score IV and type II diabetes and obstructive sleep apnea (OSA), standard dose spinal anesthesia, including hyperbaric bupivacaine and fentanyl mixture, was decided to be given. As the consequences of proper attention to special status such as easy positioning, suitable anesthesia technique, avoiding complications about airway and haemodynamics, he safely underwent to the closed reduction with singe dose spinal anesthesia.

Keywords

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Anesthetic management of a morbidly obese patient with supracondylar femur fracture

Abstract

Literatür araştırmalarımıza göre suprakondiler femur kırığı, morbid obesite ile birlikte nadir görülen bir durum değildir. Biz 46 yaşında, 168 kilo, 172 cm [vücut kitle indexi (BMİ) > 55 kg/ m2] suprakondiler femur kırığı nedeni ile internal fiksasyon ve kapalı redüksiyon uygulanacak olan morbid obez bir erkek hastayı sunduk. Hasta 10 mg oral diazepam ile premedike edildi ve hastaneye bir sedye ile getirildi ve yan yana getirilmiş iki standart ameliyat masası üzerine zorlukla alındı. Morbid obez hastada hipertansiyon, mallampati skor IV, tip II diyabet, obstrüktif uyku apnesi (OSA) gibi risk faktörleri olduğu için hiperbarik bupivakain ile fentanil içeren karışım verilmek üzere spinal anestezi planlandı. Kolay pozisyon verme, uygun anestezi tekniği, hava yolu ve hemodinami ile ilgili komplikasyonlardan kaçınma gibi özel durumlar için uygun kararın verilmesi sonucunda hastaya tek doz spinal anestezi eşliğinde güvenle kapalı redüksiyon uygulandı.

Keywords

Suprakondiler femur kýrýðý, Morbid obesite, Spinalanestezi, Vücut kitle indeksi

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