Obezite ve Anestezi
Özet
Dünya Sağlık Örgütü tarafından sağlığı tehdit eden anormal veya aşırı yağ birikimi olarak tanımlanan obezite, vücut sistemlerinde neden olduğu patofizyolojik değişikliklerle anestezi yönetimini doğrudan zorlaştıran yüksek riskli bir tablo oluşturmaktadır. Vücut Kitle İndeksi (VKİ) ve bel çevresi ölçümleriyle sınıflandırılan obezite; kardiyovasküler, solunum, endokrin, ürogenital ve gastrointestinal sistemlerde belirgin bozukluklara yol açmaktadır. Hava yolundaki yağ birikimi, kısa boyun ve sınırlı hareketlilik gibi anatomik faktörler zor maske ventilasyonu ve trakeal entübasyon insidansını artırmaktadır. Azalmış fonksiyonel rezidüel kapasite ve akciğer kompliyansı ise hastaların apne sürelerinde hızlı oksijen desatürasyonuna girmesine neden olmaktadır. İlaçların dağılım hacmi ve klirensindeki değişiklikler sebebiyle anestezik ve nöromüsküler blokör dozları İdeal Vücut Ağırlığı (İVA) veya Yağsız Vücut Ağırlığı (YVA) esas alınarak titizlikle hesaplanmalıdır. Preoperatif değerlendirmede yandaş hastalıklar, uyku apnesi ve tromboemboli riski ayrıntılı sorgulanmalı; intraoperatif dönemde rampa pozisyonu, uygun PEEP ve akciğer koruyucu ventilasyon stratejileri kullanılmalıdır. Postoperatif bakımda ise multimodal analjezi, erken mobilizasyon, uygun postür ve solunum desteği ile olası atelektazi, hipoksi ve kardiyak komplikasyonların önüne geçilmesi hedeflenmelidir.
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