Obezite ve Anestezi
Synopsis
Obesity is a major health issue associated with increased perioperative mortality and morbidity, affecting the respiratory, cardiovascular, endocrine, and gastrointestinal systems. In obese surgical patients, in addition to increased work of breathing, decreased functional residual capacity, ventilation-perfusion mismatch, and susceptibility to hypoxemia, severe respiratory disorders such as Obstructive Sleep Apnea Syndrome (OSAS) and Obesity Hypoventilation Syndrome (OHS) can be observed. Mask ventilation and tracheal intubation become difficult due to increased soft tissue in the upper airway and restricted cervical mobility, making preoxygenation, CPAP, and ramp positioning essential. In the cardiovascular system, the risks of hypertension, ischemic heart disease, left ventricular hypertrophy, and arrhythmias increase, while the risk of deep vein thrombosis is 10 times higher than in non-obese individuals due to venous stasis and hypercoagulability. Additionally, Type 2 diabetes, fatty liver disease, and gastroesophageal reflux frequently accompany obesity. Because the volume of distribution and pharmacokinetics of anesthetic drugs are altered, dosage calculations must be based on lean body weight (LBW) or ideal body weight (IBW) rather than total body weight to prevent overdose. Anesthetic management relies on detailed preoperative evaluation of patients, avoiding sedation due to the risk of respiratory depression, administering prophylaxis against thrombosis and gastric aspiration, and providing proper intraoperative positioning with ramp support.
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