Preoperative Evaluation, Anesthesia and Outcome of a Super Morbidly Obese Patient.
AJTES Vol 4, No 2, July 2020
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Keywords

Abdomen view
BMI formula
Obesity clinic,
Ramped position.

How to Cite

NAÇO, M., GANI, H., KODRA, N., ÇELIKU, E., LLUKAÇAJ, A., & NAÇO, E. (2020). Preoperative Evaluation, Anesthesia and Outcome of a Super Morbidly Obese Patient. Albanian Journal of Trauma and Emergency Surgery, 4(2), 727 - 731. https://doi.org/10.32391/ajtes.v4i2.148

Abstract

Background; Nowadays anesthesia and outcome of morbidly obese patients became not only challenges but and an obligation in abdominal surgery. Sometimes morbidly obese patients postponed from all the kinds of surgery till it is life-threatening. The ward of anesthetists is obligate for a very careful preoperative evaluation, anesthesia, and outcome of morbidity obese patients. These include the preoperative evaluation of obesity, particularly on cardiac, respiratory, and metabolic systems; airway management; perioperative management (i.e., hemodynamic, respiratory, and hyperglycemic) and postoperative care.

Case description: A 62 years old female with BMI=63.7 kg/m² with severe hypertension treatment came to a surgery ward for the plastic abdomen. After a careful preoperative preparation for the respiratory system and prophylaxis for thrombosis home, we started preoperative care 72 hours before surgery done in our hospital. We used general anesthesia for operation, the surgery lasts 190 minutes, and the patient was extubated according to weaning criteria only 16 hours after surgery. The patient stayed 2 days in intensive care and left a safe hospital on her ten days of recovery.

Discussion:  Super obese surgical patients represent numerous challenges to the anesthetist.

Conclusion: A better understanding of the pathophysiology and complications that accompany obesity may improve their care and outcome.

https://doi.org/10.32391/ajtes.v4i2.148
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References

‘Fat-burning’ molecule has implications for the treatment ofobesity Date: June 8, 2020, Source: Virginia Tech

World Health Organ Tech Rep Ser 2000;894; i-xii,1-253.

Obesity surgery 2006; 16: 1563-1569.

Anesthetic Challenges in the Obese Patient, Rudin Domi 1,HakiLaho PMID: 22562644, DOI: 10.1007/s00540-012-1408-4

Morbid Obesity--A Review, Todd A Richards 1, Alan D Kaye, Aaron M Fields, PMID: 15830765

The Pathophysiology of Obesity and Its Clinical Manifestations.Richard N. Redinger, MD Gastroenterology & Hepatology Volume 3, Issue 11 November 2007, pp 856-864.

Buchwald H. The evolution of metabolic/bariatric surgery.Obes Surg. 2014; 24(8):1126–1135. DOI: 10.1007/s11695-014-1354

https://www.asahq.org/resources/clinical-information/asa-physical-status-classification system

Demaria EJ, Murr M, Byrne TK, et al. Validation of the Obesity Surgery Mortality Risk Score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Annals of Surgery 2007;246: 578–84.

Collazo-Clavell ML. Bariatric surgery: important considerations for the primary care provider. ComprTher. 2008; 34(3–4): 159–165.

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(15): 1705–1711.

Koenig SM. Pulmonary complications of obesity. Am J Med Sci. 2001; 321(4): 249–279

Lundstrøm LH, Møller AM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor fordifficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology2009; 110: 266–74.

Brodsky JB, Lemmens HJM, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesthesia and Analgesia 2002; 94: 732–6.

Laryngoscopy and Morbid Obesity: A Comparison of the “Sniff” and “Ramped” PositionsJeremy S Collins 1, Harry J M Lemmens, Jay B Brodsky, John G Brock-Utne, Richard M Levitan PMID: 15527629, DOI: 10.1381/0960892042386869.

Flores JC. Post-anesthetic care unit management. In Morbid Obesity: Peri-Operative Management. Alvarez AO (Ed).Cambridge: Cambridge University Press, 2004.pp. 339–346.

Nightingale CE, Margarson MP, Shearer E, Redman JW,Lucas DN, Cousins JM. Perioperative management of the obese surgical patient in 2015. Anesthesia 2015; 70(7):859–876.

Naco M.&bp“PONV prophylaxis in thyroidectomy intervention according to Apfel risk score” Number 4, Vol1, suplement4, vol1, 2019 ISSN online 2521-0327 ISSN print:2521-0319.

Ziemann-Gimmel P, Hensel P, Koppman J, Marema R. Multimodal analgesia reduces narcotic requirements and antiemetic rescue medication in laparoscopic Roux-en-Y gastric bypass surgery. Surg ObesRelat Dis. 2013; 9(6): 975– 980.

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