Suprakondiler femur kırığı ile birlikte olan morbid obez hastada anestezi yönetimi

Yıl 2009, Cilt: 15 Sayı: 1, 67 - 70, 01.02.2009

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

Öz

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.

Anahtar Kelimeler

-

Anesthetic management of a morbidly obese patient with supracondylar femur fracture

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1.Grant P, Newcombe M. Emergency management of the morbidly obese. Emerg Med Australas. 2004 Aug;16(4):309-17
• 2.Von Ungern-Stenberg BS, Regli A, Reber A, Schneider MC. Comparison of perioperative spirometric data following spinal or general anaesthesia in normal- weight and over weight gynaecological patients. Acta Anaesthesiol Scand. 2005;49:940-8
• 3.Shetty RR, Mostofi SB, Housden PL. Knee dislocation of a morbidly obese patient: A case report. J Orthop Surg. 2005;13(l):76-8
• 4.Australasian Society fort the study of obesity. Prevalence of adult overweight and obesity in Australia. Media Releases. Available from URL: http: //www.asso.org.au/ 5.Gardner G, halweil B. Underfed and overfed: The global epidemic of malnutrition. World watch in stitute 2000. http://www.worldwatch.org/pubs/paper/150/ 6.Herrara MF, Lozano-Salazar RR, Gonzalez-Barranco J, Rull JA. Diseases and problems secondary to massive obesity. Eur J Gastroenterol Hepatol. 1999;ll:63-7
• 7.Duflou J, Virmani R, Rabin I, Burke A, Farb A, Smialek J. Sudden death as a resolt of heart disease in morbid obesity. Am Heart J. 1995;130:306-13
• 8.Gajraj NM, whitten CW. Morbid obesity. In: Atlee JL. Complications in Anaesthesia. Sydney: WB Saunders, 1996;848-50
• 9.Shenkman Z, Shir Y, Brodsky JB, Perioperative management of the obese patient. Br J Anaesth. 1993;70:349-59
• lO.Voyagis GS, Kyriakis KP, Dimitriou V, Viettou I. Value of oropharyngeal Mallampati classification in predicting difficult laryngoscopy among obese patients. Eur J Anaesthesiol. 1998; 15:330-4
• 11.Rose DK, Cohen MM. The airway: Problems and predictions in 18500 patients. Can J Anaesth. 1994;41;372-383
• 12.Pelosi P, Croci M, Ravagnan I et al. Respiratory system mechanics in sedated, paralysed, morbidly obese patients. J Appl Physiol. 1997;82:811-18
• 13.Biring MS, Lewis MI, Liu JI, Mohsenifar Z: Pulmonary physiologic changes of morbid obesity. Am J Med. Sci 1999;318:293-7
• 14.Pelosi P, Croci M, Calappi E, Cerisara M, Malazzi D, Vicardi P, Gattinoni L The prone position during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg. 1995;80:955-60
• 15.Kumari AS. Pregnancy outcome in vomen with morbid obesity. Int J Gynaecol Obstet. 2001;73:101-107
• 16.Reyes M, Pan PH. Very low- dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications. Int J Obstet Anesth. 2004;13:99-102
• 17.Vercauteren MP, Coppejans HC, Hoffmann VL, Saldien V, Adriaensen HA. Small-dose hyperbaric versus plain bupivacaine during spinal anesthesia for cesarian section. Anesth Analg. 1998;86:989-993
• 18.Emett A, Cowrie- Mohan S. Standard dose hyperbaric bupivacaine is safe and effective for CSE in morbidly obese patients. Int J Obstet Anesth. 2004;(7):5
• 19.National Conference of State Legislatures. Vol. 13, No. 32, www.ncsl.org
• 2O.Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JWM et al. Inter- disciplinary European guidelines on surgery of severe obesity. Int J Obesity. 2007;31:569-577