Recent advances in anesthesia of the obese patient

Jay B Brodsky, Jay B Brodsky

Abstract

The anesthetic management of an obese patient can be challenging because of the altered anatomy and physiology associated with obesity. In this article, I review the recent medical literature and highlight some of the controversies in the airway management and drug dosing of morbidly obese patients.

Keywords: Propofol; Safe Apnea Period; Sugammadex.

Conflict of interest statement

No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

References

    1. Apfelbaum JL, Hagberg CA, Caplan RA, et al. : Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70. 10.1097/ALN.0b013e31827773b2
    2. F1000 Recommendation

    1. Saasouh W, Laffey K, Turan A, et al. : Degree of obesity is not associated with more than one intubation attempt: a large centre experience. Br J Anaesth. 2018;120(5):1110–6. 10.1016/j.bja.2018.01.019
    2. F1000 Recommendation

    1. Lewis SR, Butler AR, Parker J, et al. : Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev. 2016;11:CD011136. 10.1002/14651858.CD011136.pub2
    2. F1000 Recommendation

    1. Patel A, Nouraei SA: Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015;70(3):323–9. 10.1111/anae.12923
    2. F1000 Recommendation

    1. Joseph N, Rajan S, Tosh P, et al. : Comparison of Arterial Oxygenation and Acid-Base Balance with the use of Transnasal Humidified Rapid-insufflation Ventilatory Exchange versus Tidal Volume Breathing with Continuous Positive Airway Pressure for Preoxygenation and Apneic Ventilation. Anesth Essays Res. 2018;12(1):246–50. 10.4103/aer.AER_13_18
    2. F1000 Recommendation

    1. Gleason JM, Christian BR, Barton ED: Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review. West J Emerg Med. 2018;19(2):403–11. 10.5811/westjem.2017.12.34699
    2. F1000 Recommendation

    1. Heard A, Toner AJ, Evans JR, et al. : Apneic Oxygenation During Prolonged Laryngoscopy in Obese Patients: A Randomized, Controlled Trial of Buccal RAE Tube Oxygen Administration. Anesth Analg. 2017;124(4):1162–7. 10.1213/ANE.0000000000001564
    2. F1000 Recommendation

    1. Ingrande J, Brodsky JB, Lemmens HJ: Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011;113(1):57–62. 10.1213/ANE.0b013e3181f6d9c0
    2. F1000 Recommendation

    1. Subramani Y, Riad W, Chung F, et al. : Optimal propofol induction dose in morbidly obese patients: A randomized controlled trial comparing the bispectral index and lean body weight scalar. Can J Anaesth. 2017;64(5):471–9. 10.1007/s12630-017-0852-x
    2. F1000 Recommendation

    1. Tsui BC, Murtha L, Lemmens HJ: Practical dosing of propofol in morbidly obese patients. Can J Anaesth. 2017;64(5):449–55. 10.1007/s12630-017-0853-9
    1. McVay T, Fang JC, Taylor L, et al. : Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy with Non-Anesthesia Administered Propofol Sedation. Obes Surg. 2017;27(6):1501–7. 10.1007/s11695-016-2478-4
    2. F1000 Recommendation

    1. Monk TG, Rietbergen H, Woo T, et al. : Use of Sugammadex in Patients With Obesity: A Pooled Analysis. Am J Ther. 2017;24(5):e507–e516. 10.1097/MJT.0000000000000305
    2. F1000 Recommendation

    1. Badaoui R, Cabaret A, Alami Y, et al. : Reversal of neuromuscular blockade by sugammadex in laparoscopic bariatric surgery: In support of dose reduction. Anaesth Crit Care Pain Med. 2016;35(1):25–9. 10.1016/j.accpm.2015.09.003
    2. F1000 Recommendation

    1. Loupec T, Frasca D, Rousseau N, et al. : Appropriate dosing of sugammadex to reverse deep rocuronium-induced neuromuscular blockade in morbidly obese patients. Anaesthesia. 2016;71(3):265–72. 10.1111/anae.13344
    2. F1000 Recommendation

Source: PubMed

3
Subscribe