By Jay B. Brodsky
The worldwide weight problems epidemic is becoming in severity, affecting humans of all ages and costing healthcare companies hundreds of thousands of greenbacks each year. on a daily basis, anesthesiologists are offered with overweight and morbidly overweight sufferers present process all types of surgery; the administration of those sufferers differs considerably from that of ordinary weight sufferers present process a similar process. Anesthetic administration of the overweight Surgical sufferer discusses those particular administration matters inside every one surgical uniqueness quarter. preliminary chapters describe pre-operative evaluation and pharmacology; those are through particular chapters at the anesthetic administration of a large choice of surgeries, from joint alternative to open center surgical procedure. crucial studying for anesthesiologists and nurse anesthetists world wide, Anesthetic administration of the overweight Surgical sufferer and its significant other paintings through a similar authors, Morbid weight problems: Peri-operative administration, allow either trainees and practised execs to control this complicated sufferer workforce successfully.
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Additional info for Anesthetic Management of the Obese Surgical Patient
Position Patient position, as always, is extremely important. A head-elevated or semi-recumbent position maximizes oxygenation in the post-operative period. Therefore, if hemodynamically stable the MO patient should have their airway extubated while their upper body is elevated 30–45 and then be transferred and recovered in the post-operative care unit (PACU) in that same position. Mechanical assisted ventilation MO patients should always breathe supplemental oxygen throughout their recovery. The majority of MO patients will have low oxygen saturation for up to 24 hours following major surgery if allowed to breathe air.
6. Torri G, Casati A, Albertin A et al. Randomized comparison of isoflurane and sevoflurane for laparoscopic gastric banding in morbidly obese patients. J Clin Anesth 2001; 13: 565–570. 7. Arain SR, Barth CD, Shankar H, Ebert TJ. Choice of volatile anesthetic for the morbidly obese patient: sevoflurane or desflurane. J Clin Anesth 2005; 17: 413–419. 8. Vallejo MC, Sah N, Phelps AL et al. Desflurane versus sevoflurane for laparoscopic gastroplasty in morbidly obese patients. J Clin Anesth 2007; 19: 3–8.
Although BMI is used as the standard metric for obesity, BMI cannot differentiate between fat and muscle mass so patients with a large muscle mass would receive the same dose as those with a large fat mass if BMI is used to determine dose. 1. Schematic of total body weight (TBW), fat weight and lean body weight (LBW) at different body mass indices (BMIs) in a standard height male. 1. Recommended dosing scalars for anesthetic drugs in obese patients. Drug Dosing scalar Remarks Propofol Induction: LBW Maintenance: TBW LBW dosing in MO subjects for induction required similar amounts of propofol and similar times to loss of consciousness compared with lean subjects given propofol based on TBW.