nach oben

Journal of Anesthesia

Erschienen in:

01.10.2012 | Review Article

Anesthetic challenges in the obese patient

verfasst von: Rudin Domi, Haki Laho

Erschienen in: Journal of Anesthesia | Ausgabe 5/2012

Einloggen, um Zugang zu erhalten

Abstract

Obesity seems to be the modern concern to society. An increasing number of obese patients present annually to surgical wards to undergo surgical procedures. As morbid obesity affects most of the vital organs, the anesthesiologist must be prepared to deal with several challenges. These include the preoperative evaluation of the consequences of obesity, particularly on cardiac, respiratory, and metabolic systems; airway management; different pharmacokinetic and pharmacodynamic drug regimen; and perioperative management (i.e., hemodynamic, respiratory, and hyperglycemic). This paper reviews and assesses the most important anesthetic issues in managing obese patients.

Selassie M, Sinha A. The epidemiology and etiology of obesity: a global challenge. Best Pract Res Clin Anesthesiol. 2011;25:1–9.CrossRef

Ogden C, Carroll M, Curtin L, McDowell M, Tabak C, Flegal K. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–55.PubMedCrossRef

Flegal K, Carroll M, Ogden C, Curtin L. Prevalence and trends in obesity among US Adults, 1999–2008. JAMA. 2010;303(3):235–41.PubMedCrossRef

Berghöfer A, Pischon T, Reinhold T, Apovian C, Sharma A, Willich S. Obesity prevalence from a European perspective: a systematic review. BMC Public Health. 2008;8:200.PubMedCrossRef

Stevens J. Ethnic-specific cutpoints for obesity vs country-specific guidelines for action. Int J Obes. 2003;27(3):287–8.CrossRef

Calle E, Thun M, Petrelli J, Rodriguez C, Heath C. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097–105.PubMedCrossRef

Dindo D, Muller M, Weber M, Clavien P. Obesity in general elective surgery. Lancet. 2003;361(9374):2032–5.PubMedCrossRef

Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery. 2003;134(4):613–21.PubMedCrossRef

Adams J, Murphy P. Obesity in anesthesia and intensive care. Br J Anaesth. 2000;85:91–108.PubMedCrossRef

10.

Murphy P. Obesity. In: Hemmings H, Hopkins P, editors. Foundations of anaesthesia, basic and clinical sciences. London: Mosby; 2000. p. 703–11.

11.

Westerly B, Dabbagh O. Morbidity and mortality characteristics of morbidly obese patients admitted to hospital and intensive care units. J Crit Care. 2011;26:180–5.PubMedCrossRef

12.

Lotia SH, Bellamy M. Anaesthesia and morbid obesity. Contin Educ Anaesth Crit Care. 2008;8(5):151–6.CrossRef

13.

Elamin EM. Nutritional care of the obese intensive care unit patient. Curr Opin Crit Care. 2005;11:300.PubMedCrossRef

14.

Poirier P, Giles TH, Bray G, Hong Y. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation. 2006;113:898–918.PubMedCrossRef

15.

Poirier P, Lemieux I, Mauriege P, Dewailly E, Blanchet C, Bergeron J, Despres J. Impact of waist circumference on the relationship between blood pressure and insulin: the Quebec Health Survey. Hypertension. 2005;45:363–7.PubMedCrossRef

16.

Muller D, Elahi D, Pratley R, Tobin J, Andres R. An epidemiological test of the hyperinsulinemia-hypertension hypothesis. J Clin Endocrinol Metab. 1993;76:544–8.PubMedCrossRef

17.

Backman L, Freyschuss U, Hallbert D. Cardiovascular function in extreme obesity. Acta Med Scand. 1983;149:437–9.

18.

Pontiroli A, Pizzocri P, Saibene A, Girola A, Koprivec D, Fragasso G. Left ventricular hypertrophy and QT interval in obesity and in hypertension: effects of weight loss and of normalisation of blood pressure. Int J Obes. 2004;28:1118–23.CrossRef

19.

Kenchaiah S, Evans J, Levy D, Wilson P, Benjamin E, Larson M, Kannel W, Vasan R. Obesity and the risk of heart failure. N Engl J Med. 2002;347:305–13.PubMedCrossRef

20.

Horwich T, Fonarow G, Hamilton M, MacLellan W, Woo M, Tilisch J. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol. 2001;38(3):789–95.PubMedCrossRef

21.

Lazarus R, Sparrow D, Weiss ST. Effects of obesity and fat distribution on ventilatory function: the normative aging study. Chest. 1997;111(89):1–898.

22.

American Society of Anesthesiologists Task Force. Practice guidelines for the peri-operative management of patients with obstructive sleep apnoea. A report of the American Society of Anesthesiologists Task Force. Anesthesiology. 2006;104:1081–93.

23.

Altermatt F, Muñoz H, Delfino A, Cortínez LI. Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea. Br J Anaesth. 2005;95:706–9.PubMedCrossRef

24.

den Herder C, Schmeck J, Appelboom D, de Vries N. Risks of general anaesthesia in people with obstructive sleep apnoea. BMJ. 2004;329:955.CrossRef

25.

Benumof J. Obstructive sleep apnea in the adult obese patients: implication for airway management. Anesthesiol Clin N Am. 2002;20(4):789–811.CrossRef

26.

Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154:1705–11.PubMedCrossRef

27.

Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.PubMedCrossRef

28.

O’Donnell C, Schaub C, Haines A, Berkovitz D, Tankersley C, Schwartz A, Smith Ph. Leptin prevents respiratory depression in obesity. Am J Respir Crit Care Med. 1999;159:1477–84.PubMed

29.

Brodsky J, Lemmens H, Brock-Utne J, Vierra M, Saidman L. Morbid obesity and tracheal intubation. Anesth Analg. 2002;94(3):732–6.PubMedCrossRef

30.

Juvin P, Lavaut E, Dupont H, Lefevre P, Demetriou M, Domoulin J, Desmont J. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97(2):595–600.PubMedCrossRef

31.

Domi R. The best prediction test of difficult intubation. J Anaesth Clin Pharmacol. 2010;26(2):193–6.

32.

Lundstrøm LH, Moller A, Rosenstock Ch, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish anesthesia database. Anesthesiology. 2009;110(2):266–74.PubMed

33.

Williamson JA, Webb RK, Szekely S, Gillies E, Dreosti A. The Australian Incident Monitor Study. Difficult intubation: an analysis of 2000 incident reports. Anaesth Intensive Care. 1993;21:602–7.PubMed

34.

Marchesini G, Moscatiello S, Di Domizio S, Forlani G. Obesity-associated liver disease. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S74–80.PubMedCrossRef

35.

Friedenberg F, Xanthopoulos M, Foster G, Richter J. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103(8):2111–22.PubMedCrossRef

36.

Hansson P, Eriksson H, Welin L, Svardsudd K, Vilhelmsen L. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: ‘the study of men born in 1913’. Arch Intern Med. 1999;159:1886–90.PubMedCrossRef

37.

Goldhaber S, Grodstein F, Stampfer M, Manson J, Golditz G, Speizer F, Willett W, Hennekens Ch. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277(8):642–5.PubMedCrossRef

38.

Blaszyk H, Bjornsson J. Factor V Leiden and morbid obesity in fatal postoperative pulmonary embolism. Arch Surg. 2000;135:1410–3.PubMedCrossRef

39.

Kurth T, Gaziano J, Berger K, Kase C, Rexrode K, Cook N, Buring J, Manson J. Body mass index and the risk of stroke in men. Arch Intern Med. 2002;162:2557–62.PubMedCrossRef

40.

Lopez-Jiminez F, Bhatia S, Collazo-Clavell ML, Sarr M, Somers V. Safety and efficacy of bariatric surgery in patients with coronary artery disease. Mayo Clin Proc. 2005;80(9):1157–62.CrossRef

41.

Patis S, Schneider H, Schwartz A, Smith P. Adult obstructive sleep apnea. Chest. 2007;132:325–77.CrossRef

42.

Hillman DR, Loadsman JA, Platt PR, Eastwood P. Obstructive sleep apnea and anaesthesia. Sleep Med Rev. 2004;8(6):459–71.PubMedCrossRef

43.

Beevers G, Lip GY, O’Brien E. ABC of hypertension. Blood pressure measurement. Part I-sphygmomanometry: factors common to all techniques. BMJ. 2001;322:981.PubMedCrossRef

44.

Miller AH, Roth BA, Mills TJ, Woody J, Longmoor Ch, Foster B. Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med. 2002;9(8):800–5.PubMedCrossRef

45.

Gann M Jr, Sardi A. Improved results using ultrasound guidance for central venous access. Am Surg. 2003;69:1104.PubMed

46.

Dhonneur G, Combes X, Leroux B, Duvaldestin P. Postoperative obstructive apnea. Anesth Analg. 1999;89:762–7.PubMed

47.

Ezri T, Gewurtz G, Sessler DI, Medalion P, Szmuk P, Hagbeg C, Susmailan S. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia. 2003;58:1111–4.PubMedCrossRef

48.

Shiga T, Wajima Z, Inoue T. Predicting difficult intubation. Anesthesiology. 2006;104:618–9.CrossRef

49.

Collins JS, Lemmens HJ, Brodsky JB, Brock-Utne J, Levitan R. Laryngoscopy and morbid obesity: a comparison of the ‘‘sniff’’ and ‘‘ramped’’ positions. Obes Surg. 2004;14(9):1171–5.PubMedCrossRef

50.

Curet M. Special problems in laparoscopic surgery: previous abdominal surgery, obesity, and pregnancy. Surg Clin N Am. 2000;80(4):1093–110.PubMedCrossRef

51.

McEwen DR. Intraoperative positioning of surgical patients. AORN J. 1996;63(6):1059–63.PubMedCrossRef

52.

Leykin Y, Miotto L, Pellis T. Pharmacokinetic consideration in the obese. Best Pract Res Clin Anesthesiol. 2011;25:27–36.CrossRef

53.

Ingrande J, Brodsky J, Lemmens H. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011;113(1):57–62.PubMedCrossRef

54.

Ingrande J, Lemmens H. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105(Suppl 1):i16–23.PubMedCrossRef

55.

Egan TD, Huizinga B, Gupta SK, Jaarsma R, Sperry R, Yee J, Muir K. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology. 1998;89(3):562–73.PubMedCrossRef

56.

De Baerdemaeker LEC, Jacobs S, Den Blauwen NMM. Postoperative results after desflurane or sevoflurane combined with remifentanil in morbidly obese patients. Obes Surg. 2007;16(6):728–33.CrossRef

57.

Casati A, Putzu M. Anesthesia in the obese patient: pharmacokinetic consideration. J Clin Anesth. 2005;17(2):134–45.PubMedCrossRef

58.

Coussa M, Proietti S, Schnyder P, Frascarolo Ph, Suter M, Spahn D, Magnusson L. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg. 2004;98:1491–5.PubMedCrossRef

59.

Gander S, Frascarolo P, Suter M, Spahn D, Magnusson L. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg. 2005;100(2):580–4.PubMedCrossRef

60.

Dixon BJ, Dixon JB, Carden JR. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005;102:1110–5.PubMedCrossRef

61.

The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. NEJM. 2000;342:1301–8.CrossRef

62.

O’Brien JM, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004;140:338–45.PubMed

63.

Pelosi P, Ravagnan I, Giurati G, Panigada M, Bottino N, Tredici S, Eccher G, Gattinoni L. Positive end expiratory pressure improves respiratory function in obese but no in normal subjects during anesthesia and paralysis. Anesthesiology. 1999;91:1221–31.PubMedCrossRef

64.

Perilli V, Sollazzi L, Modesti C, Annetta M, Sacco T, Bocci M, Tacchino R, Proietti R. Comparison of positive end-expiratory pressure with reverse Trendelenburg position in morbidly obese patients undergoing bariatric surgery: effects on hemodynamics and pulmonary gas exchange. Obes Surg. 2003;13:605–9.PubMedCrossRef

65.

Pelosi P, Gregoretti C. Perioperative management of obese patients. Best Pract Res Clin Anaesthesiol. 2010;24(2):211–25.PubMedCrossRef

66.

Sharma SK, McCauley J, Cottam D, Mattar S, Holover S, Dallal R, Lord J, Danner O, Ramanathan R, Eid G, Schauer Ph. Acute changes in renal function after laparoscopic gastric surgery for morbid obesity. Surg Obes Relat Dis. 2006;3:389–92.CrossRef

67.

Cotter JT, Nielsen KC, Guller U, Steele S, Klein S. 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(8):810–6.PubMedCrossRef

68.

Taivainen T, Tuominen M, Rosenberg PH. Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace. Br J Anaesth. 1990;64:542–6.PubMedCrossRef

69.

Ingrande J, Brodsky J, Lemmens H. Regional anesthesia and obesity. Curr Opin Anaesthesiol. 2009;22:683–6.PubMedCrossRef

70.

Grau T, Bartusseck E, Conradi R, Martin E, Motsch J. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anaesth. 2003;50(10):1047–50.PubMedCrossRef

71.

Wallace DH, Currie JM, Gilstrap LC, Santos R. Indirect sonographic guidance for epidural anesthesia in obese pregnant patients. Reg Anesth. 1992;17:233–6.PubMed

72.

Reyes M, Pan P. Very low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications. Int J Obes Anesth. 2004;13(2):99–102.CrossRef

73.

Brodsky J, Mariano E. Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best Pract Res Clin Anesthesiol. 2011;25:61–72.CrossRef

74.

Schumann R, Jones S, Cooper B, Kelley S, Bosch M, Ortiz V, Connor K, Kaufman M, Harvey A, Carr D. Update on best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery, 2004-2007. Obesity. 2009;17:889–94.PubMedCrossRef

Titel: Anesthetic challenges in the obese patient
verfasst von: Rudin Domi
Haki Laho
Publikationsdatum: 01.10.2012
Verlag: Springer Japan
Erschienen in: Journal of Anesthesia / Ausgabe 5/2012
Print ISSN: 0913-8668
Elektronische ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-012-1408-4

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Anesthetic challenges in the obese patient

Abstract

Neu im Fachgebiet AINS

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Update AINS

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2012

Ultrasound-guided supraclavicular central venous catheterization in patients with malignant hematologic diseases

Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine

Superior recovery profiles of propofol-based regimen as compared to isoflurane-based regimen in patients undergoing craniotomy for primary brain tumor excision: a retrospective study

Impact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgery

Peribulbar block in patients scheduled for eye procedures and treated with clopidogrel

The effects of intravenous anesthetics on mouse embryonic fibroblast viability and proliferation

Neu im Fachgebiet AINS

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Update AINS