Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000300001
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia para cirurgia bariátrica: avaliação retrospectiva e revisão da literatura

Anesthesia for bariatric surgery: retrospective evaluation and literature review

Airton Bagatini; Rubens Devildos Trindade; Cláudio Roberto Gomes; Renésio Marcks

http://dx.doi.org/10.1590/S0034-70942006000300001 Braz J Anesthesiol, vol.56, n3, p.205-222, 2006
PDF Português
PDF English
Downloads: 10
Views: 1612

Resumo

JUSTIFICATIVA E OBJETIVOS: O tratamento cirúrgico para a obesidade mórbida é forma eficaz de manutenção do controle ponderal por longo prazo. O objetivo deste trabalho foi realizar um levantamento das complicações, das comorbidades e dos principais aspectos do manuseio anestésico de pacientes submetidos à cirurgia da obesidade e comparar os resultados com os dados encontrados na literatura. MÉTODO: O trabalho foi realizado por meio de revisão bibliográfica e análise retrospectiva do prontuário dos pacientes submetidos à cirurgia bariátrica entre setembro de 2001 e dezembro de 2004. Todos foram submetidos ao mesmo procedimento, técnica de Capella, por laparotomia, realizada por uma única equipe cirúrgica e no mesmo hospital. RESULTADOS: Houve predomínio de pacientes do sexo feminino, a média de idade foi de 39,6 anos e o índice de massa corporal (IMC) médio foi de 44,65 kg/m². A hipertensão arterial sistêmica (HAS) foi a doença mais prevalente e as complicações encontradas foram trombose de veia subclávia, infecção pulmonar, bloqueio neuromuscular residual, sangramento gastrintestinal no pós-operatório, obstrução intestinal e deiscência anastomótica. O índice de mortalidade foi de 0,7%. CONCLUSÕES: As doenças como HAS e osteoartrose são muito prevalentes em pacientes obesos. Dentre as complicações do pós-operatório destacam-se as do sistema respiratório. Com isso percebe-se a importância do uso de técnica anestésica e de analgesia pós-operatória, que permita ao paciente a deambulação precoce, bem como a capacidade de respirar e tossir de forma adequada. Observou-se que muitos aspectos da anestesia do paciente obeso já estão definidos como benéficos ou prejudiciais; entretanto, vários assuntos ainda encontram-se indefinidos e cabe estudar e discutir para que se consiga melhorar cada vez mais o manuseio anestésico desses pacientes.

Palavras-chave

ANESTESIA, Geral, CIRURGIA, Abdominal, COMPLICAÇÕES, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Surgical treatment for morbid obesity is an effective way to maintain weight control in the long run. This study aimed at compiling complications, co-morbidities and major anesthetic aspects of patients submitted to bariatric procedures and at comparing results with data in the literature. METHODS: This study has reviewed the literature and retrospectively analyzed the records of patients submitted to bariatric surgery between September 2001 and December 2004. All patients were submitted to the laparotomy Capella technique performed by the same surgical team in the same hospital. RESULTS: Females were predominant, mean age was 39.6 years and mean body mass index (BMI) was 44.65 kg/m². Systemic arterial hypertension (SAH) was the most prevalente associate disease and complications observed were subclavian vein thrombosis, pulmonary infection, residual neuromuscular block, postoperative gastrointestinal bleeding, intestinal obstruction and anastomotic dehiscence. Mortality rate was 0.7%. CONCLUSIONS: Diseases such as SAH and osteoarthritis are highly prevalent in obese patients. There were major postoperative respiratory system complications. This stresses the importance of the anesthetic technique and of postoperative analgesia allowing for early ambulation and the ability to normally breathe and cough. It has been observed that several aspects of anesthesia for obese patients are already defined as beneficial or noxious; however, several subjects are still undefined and should be discussed and studied to constantly improve the anesthetic management of such patients.

Keywords

ANESTHESIA, General, COMPLICATIONS, DISEASES, SURGERY, Abdominal

References

Agren G, Narbro K, Jonsson E. Cost of in-patient care over 7 years among surgically and conventionally treated obese patients. Obes Res. 2002;10:1276-1283.

Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85:91-108.

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

Thomusch O, Keck T, Dobschütz EV. Risk factors for the intermediate outcome of morbid obesity after laparoscopically placed adjustable gastric banding. Am J Surg. 2005;189:214-218.

Rationale for the surgical treatment of morbid obesity. 2001.

Christou NV, Sampalis JS, Liberman M. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416-424.

Benotti P, Burchard KW, Kelly JJ. Obesity. Arch Surg. 2004;139:406-414.

Buchwald H, Avidor Y, Braunwald E. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-1737.

Balsiger BM, Poggio JL, Mai J. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg. 2000;4:598-605.

Maciell P. Cirurgia para obesidade. .

Auler Jr JOC, Giannini CG, Saragiotto DF. Desafios no manuseio peri-operatório de pacientes obesos mórbidos: como prevenir complicações. Rev Bras Anestesiol. 2003;53:227-236.

Brodsky JB, Lins AAA, Barbosa MSA. Anestesia para gastroplastia no paciente obeso. Rev Bras Anestesiol. 2000;50:86-87.

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.

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

Stunkard AJ. Current views on obesity. Am J Med. 1996;100:230-236.

Sum FC. Pharmacotherapy and surgery in treatment of obesity: evaluating risks and benefits. Asia Pacific J Clin Nutr. 2002;11:722-725.

Abir F, Bell R. Assessment and management of the obese patient. Crit Care Med. 2004;32:S87-S91.

Wadden TA, Phelan S. Assessment of quality of life in obese individuals. Obes Res. 2002;10(^s1):S50-S57.

Livingston EH. Procedure incidence and in-hospital complication rates of bariatric surgery in the United States. Am J Surg. 2004;188:105-110.

Fernandez AZ Jr, Demaria EJ, Tichansky DS. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239:698-703.

Courcoulas A, Schuchert M, Gatti G. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery. 2003;134(4):613-623.

Nguyen NT, Ho HS, Palmer LS. A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg. 2000;191:149-157.

Brolin RE, LaMarca LB, Kenler HA. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195-205.

Livingston EH, Huerta S, Arthur D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236:576-582.

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.

Alves Neto O, Tavares P. Síndrome da apnéia obstrutiva do sono A importância para o anestesiologista. Rev Bras Anestesiol. 1998;48:309-319.

Loadsman JA, Hillman DR. Anaesthesia and sleep apnea. Br J Anaesth. 2001;86:254-266.

Sousa LR, Porsani DF, Branco A. Posicionamento do paciente com obesidade mórbida para intubação traqueal. Rev Bras Anestesiol. 2000;50:483-484.

Cangiani LM. Obesidade mórbida e intubação traqueal. Rev Bras Anestesiol. 2005;55:256-260.

Ramaswamy A, Gonzalez R, Smith CD. Extensive preoperative testing is not necessary in morbidly obese patients undergoing gastric bypass. J Gastrointest Surg. 2004;8:159-165.

Juvin P, Lavaut E, Dupont H. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595-600.

Brodsky JB, Lemmens HJ, Brock-Utne JG. Morbid obesity and tracheal intubation. Anesth Analg. 2002;94:732-736.

Fehr SB, Zalunardo MP, Seifert B. Clonidine decreases propofol requirements during anaesthesia: effect on bispectral index. Br J Anaesth. 2001;86:627-632.

Taittonen MT, Kirvela OA, Aantaa R. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth. 1997;78:400-406.

Alves TCA, Braz JRC, Vianna PTG. Alfa2-agonistas em anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol. 2000;50:396-404.

Simonetti MPB, Valinetti EA, Ferreira FMC. Clonidina: de descongestionante nasal a analgésico potente. Considerações históricas e farmacológicas. Rev Bras Anestesiol. 1997;47:37-47.

Canturk Z, Canturk NZ, Çetinarslan B. Nosocomial infections and obesity in surgical patients. Obes Res. 2003;11:769-775.

Scholten DJ, Hoedema RM, Scholten SE. A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery. Obes Surg. 2002;12:19-24.

Baruzzi AC, Nussbacher A, Lagudis S. Trombose venosa profunda. Profilaxia. Arq Bras Cardiol. 1996;67:215-218.

Warner MA, Warner ME, Martin JT. Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology. 1994;81:1332-1340.

Damia G, Mascheroni D, Croci M. Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth. 1988;60:574-578.

Toyota K, Sakura S, Saito Y. The effect of pre-operative administration of midazolam on the development of intra-operative hypothermia. Anaesthesia. 2004;59:116-121.

Juvin P, Vadam C, Malek L. Postoperative recovery alter desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study. Anesth Analg. 2000;91:714-719.

Bensenor FEM, Auler Júnior JOC. P ET CO2 e SpO2 permitem ajuste ventilatório adequado em pacientes obesos mórbidos. Rev Bras Anestesiol. 2004;54:545-552.

De Baerdemaeker LE, Struys MM, Jacobs S. Optimization of desflurane administration in morbidly obese patients: a comparison with sevoflurane using an 'inhalation bolus' technique. Br J Anaesth. 2003;91:638-650.

Sudre ECM, Salvador MC, Bruno GE. Remifentanil versus dexmedetomidina como coadjuvantes de técnica anestésica padronizada em pacientes com obesidade mórbida. Rev Bras Anestesiol. 2004;54:178-189.

Egan T, Huizinga B, Gupta SK. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology. 1998;89:562-573.

Bagatini A, Gomes CR, Masella MZ. Dexmedetomidina: farmacologia e uso clínico. Rev Bras Anestesiol. 2002;52:606-617.

von Ungern-Sternberg BS, Regli A, Schneider MC. Effect of obesity and site of surgery on perioperative lung volumes. Br J Anaesth. 2004;92:202-207.

Griffin J, Terry BE, Burton RK. Comparison of end-tidal and transcutaneous measures of carbon dioxide during general anaesthesia in severely obese adults. Br J Anaesth. 2003;91:498-501.

Auler JO Jr, 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;94:741-748.

Schmidt A, Bagatini A. Náusea e vômito pós-operatório: fisiopatologia, profilaxia e tratamento. Rev Bras Anestesiol. 1997;47:326-334.

Kranke P, Apefel CC, Papenfuss T. An increased body mass index is no risk factor for postoperative nausea and vomiting: A systematic review and results of original data. Acta Anaesthesiol Scand. 2001;45:160-166.

Hovorka J, Korttila K, Erkola O. Gastric aspiration at the end of anaesthesia does not decrease postoperative nausea and vomiting. Anaesth Intensive Care. 1990;18:58-61.

Hechler A, Naujoks F, Ataman K. The incidence of postoperative nausea and vomiting is not effected by routinely applied manual pre-oxygenation during induction of anesthesia. Anasthesiol Intensivmed Notfallmed Schmerzther. 1999;34:648-688.

Pope GD, Birkmeyer JD, Finlayson SR. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg. 2002;6:855-861.

Eichenberger AS, Proietti S, Wicky S. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788-1792.

Perilli V, Sollazzi L, Bozza P. The effects of the reverse trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Anesth Analg. 2000;91:1520-1525.

Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491-498.

5dd42eb80e8825b635c63493 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