Anesthetic Management of the Obese Surgical Patient by Jay B. Brodsky

By Jay B. Brodsky

The worldwide weight problems epidemic is starting to be in severity, affecting humans of all ages and costing healthcare companies hundreds of thousands of greenbacks each year. each day, anesthesiologists are offered with overweight and morbidly overweight sufferers present process every kind of surgery; the administration of those sufferers differs considerably from that of standard weight sufferers present process an identical strategy. Anesthetic administration of the overweight Surgical sufferer discusses those particular administration concerns inside each one surgical distinctiveness sector. preliminary chapters describe pre-operative review and pharmacology; those are by way of distinctive chapters at the anesthetic administration of a large choice of surgeries, from joint substitute to open center surgical procedure. crucial examining for anesthesiologists and nurse anesthetists around the world, Anesthetic administration of the overweight Surgical sufferer and its better half paintings through an identical authors, Morbid weight problems: Peri-operative administration, allow either trainees and practised pros to regulate this complicated sufferer crew successfully.

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1. Risk factors for post-operative ventilatory support in obese patients. Over-sedation/over-medication with opioids Incomplete reversal of muscle relaxants CO2 retention (obstructive sleep apnea, obesity hypoventilation syndrome) Extremely long procedure with massive intra-operative fluid resuscitation Extremes of age Severe pre-existing cardiopulmonary disease Sepsis, fever or infection Airway trauma during intubation Emergency operation, trauma Procedures that normally require post-operative ventilation Extremely uncooperative patient Not surprisingly, patients with low pre-operative oxygen tension are at greater risk for post-operative hypoxemia.

Obes Surg 2011; 21: 54–60. 2. Bernstein DP. Cardiovascular physiology. In Morbid Obesity: Peri-operative Management, 2nd edition. ), pp. 1–18. Cambridge: Cambridge University Press, 2010. 3. Poirier P, Alpert MA, Fleisher LA et al. American Heart Association Obesity Committee of Council on Nutrition. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation 2009; 120: 86–95. 4. Afolabi BA, Novaro GM, Szomstein S, Rosenthal RJ, Asher CR.

In a study we performed on 100 morbidly obese patients (BMI >40 kg/m2) undergoing direct laryngoscopy, neither absolute obesity nor BMI was associated with intubation difficulties. 5. The best position for induction of general anesthesia is with the obese patient positioned in the head-elevated laryngoscopy position and with the operating room table in the reverse Trendelenburg position. This combination maximizes view during direct laryngoscopy while increasing the safe apnea period. 2). Problematic intubation was defined as when the Cormack– Lehane view on direct laryngoscopy plus the number of attempts at tracheal intubation by direct laryngoscopy equaled 3 or greater.

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