Simone Bazurro1, Lorenzo Ball2,1, Paolo Pelosi2,1. 1. Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy. 2. Policlinico San Martino IRCCS per l'Oncologia.
Abstract
PURPOSE OF REVIEW: The volume of bariatric and nonbariatric surgical procedures on obese patients is dramatically increasing worldwide over the past years. In this review, we discuss the physiopathlogy of respiratory function during anesthesia in obese patients, the stratification of perioperative risk to develop intraoperative and postoperative pulmonary complications, the optimization of airway management, and perioperative ventilation, including postoperative respiratory assistance. RECENT FINDINGS: Scores have been proposed to stratify the risk of surgical patients, some of which were specifically developed for obese patients. Most scores identify obstructive sleep apnea and elevated BMI as independent risk factors. Obese patients might be at risk of difficult intubation and mask ventilation, and also of developing postoperative pulmonary complications. Intraoperative ventilation settings affect clinical outcome, but the optimal ventilation strategy is still to be determined. Opioid-free regimens are being widely investigated. Postoperative monitoring and respiratory assistance are necessary in selected patients. Early mobilization and physiotherapy are mandatory. SUMMARY: Obese patients are at higher risk of perioperative complications, mainly associated with those related to the respiratory function. An appropriate preoperative evaluation, intraoperative management, and postoperative support and monitoring is essential to improve outcome and increase the safety of the surgical procedure.
PURPOSE OF REVIEW: The volume of bariatric and nonbariatric surgical procedures on obesepatients is dramatically increasing worldwide over the past years. In this review, we discuss the physiopathlogy of respiratory function during anesthesia in obesepatients, the stratification of perioperative risk to develop intraoperative and postoperative pulmonary complications, the optimization of airway management, and perioperative ventilation, including postoperative respiratory assistance. RECENT FINDINGS: Scores have been proposed to stratify the risk of surgical patients, some of which were specifically developed for obesepatients. Most scores identify obstructive sleep apnea and elevated BMI as independent risk factors. Obesepatients might be at risk of difficult intubation and mask ventilation, and also of developing postoperative pulmonary complications. Intraoperative ventilation settings affect clinical outcome, but the optimal ventilation strategy is still to be determined. Opioid-free regimens are being widely investigated. Postoperative monitoring and respiratory assistance are necessary in selected patients. Early mobilization and physiotherapy are mandatory. SUMMARY:Obesepatients are at higher risk of perioperative complications, mainly associated with those related to the respiratory function. An appropriate preoperative evaluation, intraoperative management, and postoperative support and monitoring is essential to improve outcome and increase the safety of the surgical procedure.
Authors: Christian Guido Ruf; Simon Krampe; Cord Matthies; Petra Anheuser; Tim Nestler; Jörg Simon; Hendrik Isbarn; Klaus Peter Dieckmann Journal: World J Surg Oncol Date: 2020-09-24 Impact factor: 2.754