Jacobs Journal of Anesthesiology and Research

Anesthetic Management of Laparoscopic Surgery in Obese Patients

* Bret D. Alvis
Department Of Anesthesiology, Vanderbilt University Medical Center, United States

*Corresponding Author:
Bret D. Alvis
Department Of Anesthesiology, Vanderbilt University Medical Center, United States
Email:bret.d.alvis@vanderbilt.edu

Published on: 2018-08-24

Abstract

Obesity is a situation increasing globally, evaluated as a disease and which creates serious health risks. Obese patients may encounter serious difficulties with mask ventilation and intubation during anesthesia. Body mass index (BMI) is mainly used for the definition of obesity. However, in definition of obesity BMI is insufficient and the fat distribution pattern around the waist line is a better indicator. Obesity causes significant changes in metabolic, cardiovascular and pulmonary functions and these changes increase anesthesia risks. A successful anesthesia method for laparoscopic interventions in obese patients requires coordinated team work involving multiple disciplines and well-designed care. To ensure the best results and reduce complications, it is important to deal with the changed physiology of these types of patients. In this review our aim is to determine an approach to preoperative evaluation, general anesthesia, laparoscopic procedures and postoperative complications and intensive care of obese patients in light of the literature.

Keywords

obesity; anesthesia; laparoscopy

Introduction

Obesity is a proinflammatory multisystemic disease defined as an increase in diameter of cells (hypertrophy) and/or numbers of cells (hyperplasia) in fat storage. The body mass index (BMI) is used in the definition of obesity. Body mass index 30 kg/m2 is obese, BMI >40 kg/m2 or BMI >35 kg/m2 and accompanying disease (like hypertension, diabetes mellitus) is defined as morbid obesity. Additionally obesity may be named according to anatomic distribution of fat tissue. In patients with fat around the abdominal region it is android type, whereas patients with fat distributed around the hips and legs have gynecoid type obesity. According to research, in our country 26.4% of the adult male population and 38.5% of the female population are obese. Parallel to the increase in BMI in obesity, the risk of both difficult airway management, and accompanying diseases increasing morbidity and mortality such as hypertension, diabetes mellitus, coronary artery disease and congestive heart failure and respiratory problems increases. Increased basal metabolic rate, high oxygen consumption and carbon dioxide production make patients more susceptible to rapid desaturation3.