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Anesthetic Considerations for Obese Patients

Anesthetic Considerations In Patients With Obesity Pathophysiology Driving Anesthetic Management Goal Anesthetic Intervention Excess body fat in mouth and pharynx ↑ Total body fat & fat-free mass ↑ Mallampati score ↑ Neck circumference Loss of muscle tone in pharynx & tongue following neuromuscular blocking drugs Airway access difficulty & ↑ Intubation time ↑ Respiratory rate ↓ Time to desaturation Hypoventilation while supine ↓ Functional residual capacity ↑ Gastric aspiration risk ↑ Dosage requirements of lipophilic drugs ↑ Drug metabolism & clearance ↑ Energy cost of weight-bearing activity ↑ Basal metabolic rate ↓ Total respiratory compliance Excess weight compresses lungs Airway obstruction ↑ Oxygen required ↓ Functional residual capacity ↑ Work of breathing Secure a patent airway & avoid hypoxemia Optimize positioning Maintain oxygenation & lung protection Aspiration prophylaxis Achieve optimal anesthetic dosing for altered distribution Optimize anesthetic dosing for altered metabolism & clearance Intubate via endotracheal tube, avoid supraglottic airway device Consider video laryngoscopy Use head-elevated laryngoscopy positioning (“sniffing” position) Pre-oxygenate to ↑ oxygen reserve during intubation Avoid supine positioning, in place of alternate positioning (i.e., reverse trendelenburg) Lung-protective ventilation (↓ tidal volume, optimize oxygen levels, positive end expiratory pressure & recruitment maneuvers) Pre-operative fasting, gastric ultrasound to assess volume Rapid sequence induction to reduce aspiration risk Adjust drug dosages based on individual recommendations to account for altered distribution, metabolism & clearance Excess body fat on chest wall Excess intra- abdominal fat ↑ Gastric volume Excess body fat ↑ Circulating blood volume Obesity- related restrictive lung disease ↑ Load compressing chest wall BMI ≥30 kg/m2 Note: effects vary with the severity of obesity ↑ Pressure on diaphragm and lungs ↓ Outward chest wall force ↑ Abdominal pressure ↑ Fat acts as a reservoir for lipophilic drugs ↑ Fat storage in hepatocytes ↑ Cardiac output ↑ Pressure on gastric contents ↑ Distribution half-life of lipophilic drugs ↑ Volume of distribution for lipophilic drugs ↑ Hepatic cytochrome transcription ↑ Glomerular filtration rate and hepatic blood flow Authors: Brianna Rosgen Reviewers: Kayleigh Yang Ran Marissa Zhang Karl Darcus* * MD at time of publication Legend: Pathophysiology Mechanism Goal Anesthetic Intervention Published Nov 8, 2023 on www.thecalgaryguide.com

Considerations anesthesiques chez les patients souffrant dobesite

Considérations anesthésiques chez les patients souffrant d'obésité