Obesidad, cirugía y anestesia

Efecto del neumoperitoneo sobre los parámetros hemodinámicos en pacientes obesos mórbidos. The effect of pneumoperitoneum on haemodynamic parameters in morbidly obese patients. Gaszynski T. tomgaszyn@poczta.onet.pl Anestezjol Intens Ter. 2011 Jul-Sep;43(3):148-52. Abstract BACKGROUND: The type of anaesthetic used affects the cardiovascular function in morbidly obese patients during pneumoperitoneum. In this prospective randomized study, we evaluated the influence of inhalation anaesthesia with sevoflurane or intravenous anaesthesia with propofol on haemodynamic performance in obese patients during laparoscopy. METHODS: Patients scheduled for laparoscopic bariatric procedures were randomly divided into two groups: sevoflurane (group S) or propofol (group P). Haemodynamic function was measured using the transoesophageal Doppler method after induction of anaesthesia (T1), insuflation of CO2 (T2) and in the anti-Trendelenburg position with pneumoperitoneum (T3). RESULTS: One hundred patients were enrolled in the study. The demographic data did not differ between the groups. At T2, the blood flow parameters and ventricle ejection parameters decreased in both groups whereas the systemic vascular resistance and mean arterial pressure increased. The heart rate was stable. At T3, afterload parameters and heart rate increased in both groups yet blood flow parameters decreased in group P. The changes observed were not accompanied by any serious clinical signs of cardiovascular deterioration. CONCLUSIONS: Pneumoperitoneum has an important negative impact on haemodynamic function in morbidly obese patients but those changes are not accompanied by severe cardiovascular disturbances. Volatile anaesthesia provides better haemodynamic stability during laparoscopic bariatric surgery in such patients. http://anestezjologia.net/en/articles/item/19931/the_effect_of_ pneumoperitoneum_on_haemodynamic_parameters_in_morbidly_obese_patients   Factores de riesgos perioperatorios en pacientes obesos para cirugía bariátrica: una experiencia en Singapur Perioperative risk factors in obese patients for bariatric surgery: a Singapore experience. Iyer US, Koh KF, Chia NC, Macachor J, Cheng A. Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828. uma_shridhar@rediffmail.com Singapore Med J. 2011 Feb;52(2):94-9. Abstract INTRODUCTION: Morbid obesity and obstructive sleep apnoea (OSA) are increasingly encountered in anaesthetic practice today. Difficult intubation may be seen more frequently in our practice. This high-risk group may also be more prone to complications in the postoperative period. METHODS: We reviewed a consecutive series of patients who had undergone laparoscopic gastric banding at our institution from 2001 to 2006. The incidence of difficult intubation, early postoperative complications and its attendant risk factors were studied. RESULTS: Severe OSA and neck circumference greater than 44 cm were factors associated with difficult intubation in morbidly obese patients who presented for bariatric surgery. Asthma and increasing age may be associated risk factors for adverse events in the postoperative period. CONCLUSION: It is important to anticipate and prepare for a difficult intubation scenario in patients with severe OSA and a larger neck circumference. Close monitoring is recommended for patients with respiratory comorbidities and advanced age. http://smj.sma.org.sg/5202/5202a6.pdf  Los efectos de la apertura abdominal sobre la mecánica respiratoria durante anestesia general para cirugía bariátrica en obesos mórbidos. The effects of abdominal opening on respiratory mechanics during general anaesthesia for open bariatric surgery in morbidly obese patients. Gaszyński TM. Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Poland. tomasz.gaszynski@umed.lodz.pl Anestezjol Intens Ter. 2010 Oct-Dec;42(4):172-4. Abstract BACKGROUND: Morbid obesity BMI 40 kg mL-2 is associated with several changes in anatomy and physiology of the respiratory system. Respiratory work is increased whereas compliance of the chest wall and lungs is decreased. Increased intra-abdominal pressure compresses the diaphragm and reduces its movability. Abdominal opening should influence respiratory mechanics. METHODS: Forty-seven morbidly obese patients (BMI 49.54 ± 7.21 kg m-2) scheduled for elective bariatric surgery (open Roux-en-Y-Gastric Bypass - RYGB) were included in the study and divided into 3 groups: 40< BMI <50, 50< BMI <60 and BMI >60. Measurements were performed during general anaesthesia at two time points: before (T1) and after abdominal opening (T2). All patients were ventilated using the volume control mode. RESULTS: Preoperative spirometry revealed significantly decreased FEV 1% in the BMI >60 group. The conditions of mechanical ventilation during general anaesthesia deteriorated with an increasing BMI. After abdominal opening,the mechanical ventilation conditions improved: increased lung compliance and decreased airway pressures. The difference was statistically significant in the entire population studied. After dividing the population into groups, however, the difference was no longer significant in patients with BMI >60. The most significant difference in peak and plateau pressures after abdominal opening was observed in patients with BMI <50. CONCLUSION: Abdominal opening improves the conditions of mechanical ventilation in morbidly obese patients; when BMI is over 60 kg m-2, this improvement may not be relevant. http://anestezjologia.net/en/articles/item/19127/the_effects_of_abdominal _opening_on_respiratory_mechanics_during_general_anaesthesia_for_open _bariatric_surgery _in_morbidly_ obese_patients

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