Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000200010
Brazilian Journal of Anesthesiology
Miscellaneous

Desafios no manuseio peri-operatório de pacientes obesos mórbidos: como prevenir complicações

Challenges in perioperative management of morbidly obese patients: how to prevent complications

José Otávio Costa Auler Junior; Cindy Galvão Giannini; Daniel Fernandes Saragiotto

http://dx.doi.org/10.1590/S0034-70942003000200010 Braz J Anesthesiol, vol.53, n2, p.227-236, 2003
PDF
Downloads: 0
Views: 981

Resumo

JUSTIFICATIVA E OBJETIVOS: A incidência de Obesidade Mórbida tem aumentado significativamente nas últimas décadas, especialmente nos países desenvolvidos. Os excelentes resultados observados com o tratamento cirúrgico desta condição têm feito ressurgir o interesse no manuseio anestésico deste grupo de pacientes. O objetivo deste estudo foi enfatizar pontos vitais para o anestesiologista que lida com tais pacientes. CONTEÚDO: Distúrbios cardiovasculares, respiratórios, endócrinos e metabólicos são freqüentemente associados à obesidade e podem causar repercussões de significado clínico importantes no período peri-operatório nestes pacientes. Alguns aspectos de interesse prático à anestesia são discutidos nesta revisão. CONCLUSÕES: Além da ênfase dada às complicações mais importantes e mais freqüentemente observadas e de como preveni-las, destacamos também a importância do uso do PEEP e de volumes correntes adequados, recomendando seu uso.

Palavras-chave

ANESTESIA, CIRURGIA, CIRURGIA, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: The incidence of morbid obesity has significantly increased in recent years, especially in developed countries. Excellent results of the surgical treatment of such condition have raised the interest in the anesthetic management of such patients. This study aimed at emphasizing critical issues for anesthesiologists dealing with morbidly obese patients. CONTENTS: Cardiovascular, respiratory, endocrine and metabolic changes have been frequently associated to obesity and may cause significant clinical repercussions in the perioperative period of such patients. Some practical anesthetic issues are discussed in this review. CONCLUSIONS: In addition to emphasizing most significant and frequent complications and their prevention, the importance of PEEP and adequate tidal volumes is also highlighted.

Keywords

ANESTHESIA, DISEASES, SURGERY, SURGERY

References

Naslund E, Backman L, Granstrom L. Seven year results of vertical banded gastroplasty for morbid obesity. Eur J Surg. 1997;163:281-286.

Buckley FP. Anesthesia for the morbidly obese patient. Can J Anaesth. 1994;41:94-100.

Amaral CRT, Cheibub ZB. Obesidade mórbida: implicações anestésicas. Rev Bras Anestesiol. 1991;41:273-279.

Braga AFA, Silva ACM, Cremonesi E. Obesidade mórbida: considerações clínicas e anestésicas. Rev Bras Anestesiol. 1999;49:201-212.

Lins AAA, Barbosa MSA, Brodsky JB. Anestesia para gastroplastia no paciente obeso. Rev Bras Anestesiol. 1999;49:282-287.

Oliveira Filho GR, Nicolodi THC, Garcia JHS. Problemas clínicos pré-anestésicos de pacientes morbidamente obesos submetidos a cirurgias bariátricas: comparação com pacientes não obesos. Rev Bras Anestesiol. 2002;52:217-222.

McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207-2212.

Brolin RE. Update: NIH consensus conference. Gastrointestinal surgery for severe obesity. Nutrition. 1996;12:403-404.

Domínguez-Cherit G, Gonzalez R, Borunda D. Anesthesia for morbidly obese patients. World J Surg. 1998;22:969-973.

Shenkman Z, Shir Y, Brodsky JB. Perioperative management of the obese patient. Br J Anaesth. 1993;70:349-359.

Bray GA. Pathophysiology of obesity. Am J Clin Nutr. 1992;55:488S-494S.

Harrison GG. Height-weight tables. Ann Intern Med. 1985;103(6pt2):989-994.

Ashwell M, Chinn S, Stalley S. Female fat distribution: a simple classification based on two circumference measurements. Int J Obes. 1982;6:143-152.

Abraham S, Johnson CL. Prevalence of severe obesity in adults in the United States. Am J Clin Nutr. 1980;33(^s2):306-309.

De Divitis O, Fazio S, Petitto M. Obesity and cardiac function. Circulation. 1981;64:477-482.

Laaban JP, Cassuto D, Orvoen-Frija E. Cardiorespiratory consequences of sleep apnea syndrome in patients with massive obesity. Eur Respir J. 1998;11:20-27.

Kral JG. Morbid obesity and related health risks. Ann Intern Med. 1985;103(6pt2):1043-1047.

Dustan HP. Obesity and hypertension. Ann Intern Med. 1985;103(6pt2):1047-1049.

Alpert MA, Terry BE, Cohen MV. The electrocardiogram in morbid obesity. Am J Cardiol. 2000;85:908-910.

Drenick EJ, Fisler JC. Sudden cardiac arrest in morbidly obese surgical patients unexplained after autopsy. Am J Surg. 1988;155:720-726.

Alpert MA, Lambert CR, Panayiotou H. Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss. Am J Cardiol. 1995;76:1194-1197.

Alpert MA, Lambert CR, Terry BE. Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity. Am Heart J. 1995;130:1068-1073.

Alpert MA, Hashimi MW. Obesity and the heart. Am J Med Sci. 1993;306:117-123.

Farebrother MJB. Respiratory function and cardiorespiratory response to exercise in obesity. Br J Dis Chest. 1979;73:211.

Vaughan RW. Pulmonary and Cardiovascular Derangement’s in the Obese Patients. Anesthetics and the Obese Patient. 1982:19.

Lopata M, Onal E. Mass loading, sleep apnea, and the pathogenesis of the obesity hypoventilation. Am Rev Respir Dis. 1982;126:640-645.

Luce JM. Respiratory complications of obesity. Chest. 1980;78:626-631.

Rubisntein I, Zamel N, DuBarry L. Airflow limitation in morbidly obese nonsmoking men. Ann Intern Med. 1990;112:828-832.

Sharp JT, Henry SK, Sweany WR. Total work of breathing in normal and obese men. J Clin Invest. 1964;43:728-739.

Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377-382.

Suratt PM, Wilhoit CS, Hsiao HS. Compliance of chest wall in obese subjects. J Appl Physiol. 1984;57:403-407.

Van Lith P, Johnson FN, Sharp JT. Respiratory elastances in relaxed and paralyzed states in normal and abnormal men. J Appl Physiol. 1967;23:475-486.

Pelosi P, Croci M, Ravagnan I. Total respiratory system, lung and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109:144-151.

Pelosi P, Croci M, Ravagnan I. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange general anesthesia. Anesth Analg. 1998;87:654-660.

Auler Jr JOC, Miyoshi E, Fernandes CR. Respiratory system resistance during laparotomy in morbidly obese patients. Am J Respir Crit Care Med. 2000;161(3Pt2):A693.

Auler Jr JOC, Miyoshi E, Fernandes CR. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study. Anesth Analg. 2002;94:471-478.

Hedenstierna G, Santesson J. Breathing mechanics, dead space and gas exchanges in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand. 1976;20:248-254.

Auler Jr JOC, Fernandes CR, Miyoshi E. Anestesia para gastroplastia no paciente obeso. Rev Bras Anestesiol. 2000;50:86.

Brodsky JB, Lins AAA, Barbosa MAS. Anestesia para gastroplastia no paciente obeso. Rev Bras Anestesiol. 2000;50:87.

Bardoczky GI, Yernault JC, Houben JJ. Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia. Anesth Analg. 1995;81:385-388.

Pelosi P, Ravagnan I, Giurati G. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology. 1999;91:1221-1231.

Öberg B, Poulsen TD. Obesity: an anaesthetic challenge. Acta Anaesthesiol Scand. 1996;40:191-200.

Dumont L, Mattys M, Mardirosoff C. Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients. Acta Anaesthesiol Scand. 1997;41:408-413.

Pelosi P, Croci M, Calappi E. Prone positioning improves pulmonary function in obese patients during general anesthesia. Anesth Analg. 1996;83:578-583.

Fox GS, Whalley DG, Bevan DR. Anaesthesia for the morbidly obese experience with 110 patients. Br J Anaesth. 1981;53:811-816.

Salem MR, Dalal FY, Zygmunt MP. Does PEEP improve intraoperative arterial oxygenation in grossly obese patients?. Anesthesiology. 1998;48:280-281.

Eriksen J, Andersen J, Rasmussen JP. Postoperative pulmonary function in obese patients after upper abdominal surgery. Acta Anaesthesiol Scand. 1977;21:336-341.

Söderberg M, Thomson D, White T. Respiratory, circulation and anaesthetic management in obesity: Investigation before and after jejuno-ileal bypass. Acta Anaesthesiol Scand. 1977;21:55-61.

Berthoud MC, Peacock JE, Reilly CS. Effectiveness of preoxygenation in morbidly obese patients. Br J Anesth. 1991;67:464-466.

Lee JJ, Larson RH, Buckley JJ. Airway maintenance in the morbidly obese. Anesth Rev. 1980;7:33-37.

Buckley PF. Anesthesia and obesity and Gastrointestinal Disorders. Clinical Anesthesia. 1996:975.

Abernethy DR, Greenblatt DJ. Pharmacokinetics of drugs in obesity. Clin Pharmacokinet. 1982;7:108-124.

Higuchi H, Satoh T, Arimura S. Serum inorganic fluoride levels in mildly obese patients during and after sevoflurane anesthesia. Anesth Analg. 1993;77:1018-1021.

5ddc4a8e0e8825003ef2c91e rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections