Obese Patient. A Challenge For The Anaesthesiologist?

Aurika Karbonskienė1, Žilvinas Jucius2, Gabrielė Kybartaitė2 

1Department of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania;

2Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania.


           As the number of obese patients in the world increases, the requirement of anaesthesia for obese surgical patients increases as well. Obesity is defined based on the body mass index. World Health Organisation (WHO) classifies a person as obese when the BMI is 30 kg/m2 and over. The anaesthesiologist’s role during surgery for obese patients is vital throughout all perioperative period. While assessing the patient before operation, greater attention should be given to diagnosing obstructive sleep apnoea, obesity hypoventilation syndrome, diabetes mellitus, and diseases of the cardiovascular system. Before the surgery, it is recommended to make sure whether the catheterization of the peripheral vein is possible, also to routinely administer medication for the prevention of thrombosis and aspiration. Furthermore, the ramp position must be provided before intubation. Because of considerable adipose tissue the pharmacokinetics of medication change for obese patients. Therefore, a variety of scalars are used to calculate the proper dosage. Preoxygenation under constant positive airway pressure is recommended for prolonging of safe apnoea time. While choosing the optimal method for anaesthesia it is crucial to consider if airway management will be necessary, however, the primary choice should be regional anaesthesia. Obesity contributes to more difficult intubation; therefore, the usage of a video laryngoscope is recommended. Endotracheal tube size should be chosen based on the ideal weight scale. During the operation of an obese patient, the aim is to maintain high PEEP and to perform a lung recruitment manoeuvre. Multimodal analgesia or other certain regional anaesthesia methods can decrease the need for opioids during the postoperative period.

Keywords: obesity, anaesthesia, AV parameters, intubation, extubation, postanaesthetic care, preoxygenation.