Peer-Reviewed Journal Details
Mandatory Fields
Neligan, PJ
2010
June
Current Opinion In Anesthesiology
Metabolic syndrome: anesthesia for morbid obesity
Published
()
Optional Fields
atelectasis bariatric surgery BiPAP CPAP metabolic syndrome NASH obesity obstructive sleep apnea type 2 diabetes POSITIVE-AIRWAY-PRESSURE END-EXPIRATORY PRESSURE OBSTRUCTIVE SLEEP-APNEA BODY-MASS INDEX CARDIOVASCULAR-DISEASE MORTALITY DIFFICULT TRACHEAL INTUBATION PERIOPERATIVE BETA-BLOCKADE INSULIN-RESISTANCE POSTOPERATIVE HYPOXEMIA GENERAL-ANESTHESIA
23
375
383
Purpose of reviewThere is an emerging epidemic of obesity worldwide resulting in a greater number of obese patients presenting for surgery. The combined problems of metabolic disease and mechanical impairment from excess tissues present a variety of problems for the anesthesiologist.Recent findingsObesity is associated with nonalcoholic fatty liver disease, dyslipidemia, hyperglycemia and type 2 diabetes. Metabolic syndrome, a constellation of findings associated with visceral obesity, appears to confer additional long-term risk. To date no intervention has proven effective in reducing perioperative risk, although statin therapy is promising. Obese patients are more difficult to intubate in the 'sniffing' position, but placed in the 'ramped' position there is no evidence that this risk is greater than in the general population. Obstructive sleep apnea is associated with adverse postoperative outcomes. Much research has focused on preventing postoperative atelectasis. Preoxygenation with continuous positive airway pressure (CPAP), recruitment maneuvers, intraoperative positive end-expiratory pressure of at least 8cmH(2)O and postextubation CPAP appear to improve postoperative pulmonary function.SummaryCurrent studies have focused on the immediate impact of obesity on anesthesia and postoperative care. Future research will focus primarily on perioperative metabolic optimization.
DOI 10.1097/ACO.0b013e328338caa0
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