By Jay B. Brodsky
The worldwide weight problems epidemic is growing to be in severity, affecting humans of all ages and costing healthcare services hundreds of thousands of bucks each year. on a daily basis, anesthesiologists are awarded with overweight and morbidly overweight sufferers present process all types of surgery; the administration of those sufferers differs considerably from that of ordinary weight sufferers present process an identical method. Anesthetic administration of the overweight Surgical sufferer discusses those particular administration concerns inside each one surgical uniqueness sector. preliminary chapters describe pre-operative evaluation and pharmacology; those are by way of distinct chapters at the anesthetic administration of a large choice of surgeries, from joint alternative to open middle surgical procedure. crucial examining for anesthesiologists and nurse anesthetists around the world, Anesthetic administration of the overweight Surgical sufferer and its spouse paintings through a similar authors, Morbid weight problems: Peri-operative administration, let either trainees and practised execs to control this complicated sufferer workforce successfully.
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Extra info for Anesthetic Management of the Obese Surgical Patient
Higher doses based on TBW will cause hypotension and bradycardia. Once a remifentanil infusion has been discontinued, its effects terminate within 5–10 minutes. If post-operative pain is anticipated alternative analgesics must be administered prior to stopping remifentanil. Clinically there is no preferred inhaled anesthetic for MO patients, and any of the commonly used anesthetics (isolurane, desflurane, sevoflurane) can be used. 0 mg/kg TBW) is the drug of choice for tracheal intubation in MO patients.
General considerations Section 1 Chapter 4 Pharmacologic considerations Background The “margin of safety” for dosing anesthetic agents is narrow in MO patients. Their decreased cardiopulmonary reserve places them at risk for adverse cardiac and respiratory events, and incorrect drug dosing can further increase the rate of peri-operative complications. Morbid obesity alters the pharmacokinetics (PK) and pharmacodynamics (PD) of anesthetic agents and changes in body composition alter distribution and clearance.
15. Brodsky JB, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg 2002; 94: 732–736. 16. Grant SA, Breslin DS, MacLeod DB, Gleason D, Martin G. Dexmedetomidine infusion for sedation during fiberoptic intubation: a report of three cases. J Clin Anesth 2004; 16: 124–126. 17. Keller C, Brimacombe J, Kleinsasser A, Brimacombe L. The Laryngeal Mask Airway ProSeal(TM) as a temporary ventilatory device in grossly and morbidly obese patients before laryngoscope-guided tracheal intubation.
Anesthetic Management of the Obese Surgical Patient by Jay B. Brodsky