Anestéziológia a intenzívna medicína 2/2013

Perioperative management of obese patient

Obesity is a problem, involving different disciplines of medicine. Some of them treat the causes of obesity or its complications, while anaesthetist must solve the problem of perioperative management, including anaesthesia, conecting to intercurrent illnesses and states, which can be in relation with obesity (bariatric surgery) or not (cholecystectomy, ileus, trauma, Caesarean section, obstetric analgesia). Obesity is an illness caused by physiological dysfunction of organism influenced with environment, behaviour, endocrine organs failure, genetics. Factors influencing regulation of body mass are hypothalamus, leptin, ghrelin, sympathetic and parasympathetic nervous system, inzulin, neuropeptid Y. Perioperative management has to include exact preoperative assessment with identification of failures coexisting with obesity – cardiovascular diseases, obstructive sleep apnoea, airways disturbances, estimation of total and active body weight, which are important for calculation of drugs doses used during anaesthesia, the choice of anaesthesia – general vs regional, and planning of postoperative care, when complications can be expected mainly from airways side is also very important.

Keywords: obesity, anaesthesia, obstructive sleep apnoea, metabolic syndrome.