Anestesia para obesidade mórbida

Michelle Nacur Lorentz; Viviane Ferreira Albergaria; Frederico Augusto Soares de Lima

doi:10.1590/S0034-70942007000200010

Review Article

Anestesia para obesidade mórbida

Anesthesia for morbid obesity

Michelle Nacur Lorentz; Viviane Ferreira Albergaria; Frederico Augusto Soares de Lima

http://dx.doi.org/10.1590/S0034-70942007000200010 Braz J Anesthesiol, vol.57, n2, p.199-213, 2007

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JUSTIFICATIVA E OBJETIVOS: A obesidade mórbida é uma doença muito freqüente em nosso meio, enquanto nos EUA já assumiu caráter epidêmico. O paciente obeso apresenta uma série de alterações fisiopatológicas, além de importantes comorbidades, o que exige do anestesiologista pleno conhecimento da fisiopatologia da doença. O procedimento cirúrgico de redução gástrica tem sido cada vez mais realizado e o período perioperatório apresenta características únicas com alterações cardiovascular e pulmonar que o tornam um verdadeiro desafio para os profissionais envolvidos. O hospital também deve estar preparado para receber esses pacientes, com equipamentos adequados, equipe multidisciplinar e cuidados pós-operatórios. O objetivo deste estudo foi demonstrar que o paciente obeso mórbido não é apenas um paciente com excesso de peso, e, portanto, procurou-se nortear as principais condutas a serem observadas. CONTEÚDO: São apresentadas neste artigo as principais alterações fisiopatológicas do obeso mórbido, bem como dados de epidemiologia e doenças correlacionadas. É realizada uma revisão das doses dos medicamentos usados na anestesia, bem como a melhor abordagem pré-, intra- e pós-operatória pelo anestesiologista. CONCLUSÕES: A abordagem do paciente com obesidade mórbida exige um planejamento minucioso que se inicia na seleção dos pacientes, tem continuidade com pré-operatório detalhado e intra-operatório individualizado, e se estende até o pós-operatório, quando a incidência de complicações pulmonar, cardiovascular e infecciosa é maior que na população não-obesa. Para que os resultados sejam favoráveis é extremamente importante o envolvimento de uma equipe multiprofissional que inclui Clínica Geral, Anestesiologia, Cirurgia Geral, Enfermagem, Psicologia, Fisioterapia, Nutrologia e Terapia Intensiva.

Palavras-chave

CIRURGIA, Abdominal, DOENÇAS, Obesidade

Abstract

BACKGROUND AND OBJECTIVES: Morbid obesity is very frequent in our society, having achieved the level of an epidemic in the United States. Obese patients present several physiopathologic changes and important comorbidities, which the anesthesiologist must be aware of. Gastric reduction surgery is increasingly more frequent, and the perioperative period has unique characteristics, with cardiovascular and pulmonary changes that make it a real challenge for the professional involved. The hospital should also be prepared to receive those patients, with adequate equipment, a multidisciplinary team, and postoperative care. The objective of this study was to demonstrate that the patient with morbid obesity is not only a person with weight excess and, therefore, we attempted to describe the main conducts to be followed. CONTENTS: Here we present the main physiopathologic changes in the patient with morbid obesity, as well as the epidemiological data and correlated diseases. We review the doses of the drugs used in anesthesia, and the best pre, intra, and postoperative approach. CONCLUSIONS: The care of the patient with morbid obesity demands careful planning, which begins with patient selection, continues with a detailed preoperative and individualized intraoperative periods, and extends through the postoperative period, when the incidence of pulmonary, cardiovascular, and infectious complications is greater than in the non-obese population. The involvement of a multidisciplinary team, including Internal Medicine, Anesthesiology, General Surgery, Nursing, Psychology, Physical Therapy, Nutrition, and Intensive Care, is extremely important for good results.

Keywords

DISEASES, Obesity, SURGERY, Abdominal

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Anestesia para obesidade mórbida

Anesthesia for morbid obesity

Michelle Nacur Lorentz; Viviane Ferreira Albergaria; Frederico Augusto Soares de Lima

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