Obesity leads to many physiological changes in the body and greatly increases anesthetic risks. Therefore, the dose of anesthetic depends on the severity of obesity and on clinical peculiarities of related risk factors.
Preparing an obese patient for surgery, anesthesiologist should take into account all the changes in the respiratory tract, cardiovascular system, gastrointestinal tract, urogenital system, endocrine system, musculoskeletal system and many other systems and organs.
Having estimated potential risks that may occur due to related pathologies, anesthesiologist can choose an effective and safe anesthesia method, as well as optimal dose of general or local anesthesia.
Important changes in the cardiovascular system for anesthesiologist
- Risk of arrhythmia due to fat deposits in myocardium
- Risk of myocardial ischemia due to increased oxygen demand
- Risk of heart failure due to progressing obesity
- Risk of aortocaval compression syndrome (especially in regional amnesia)
- Risk of venous trauma during puncture and catheterization
- Risk of thromboembolic complications.
Important changes in the gastrointestinal tract for anesthesiologist
- High risk of regurgitation and aspiration
- Impaired metabolism of medications
- High risk of coagulopatia.
In addition, high intra-abdominal pressure can
- Increase intrathoracic and intracranial pressure
- Deteriorate the pulmonary mechanics and alveolar gas exchange
- Strengthen the aortocaval compression severity
- Reduce the volume of epidural space
- Strengthen the bacterial contamination from the GIT.
Important changes in the urinary system for anesthesiologist
- High risk of infection
- High risk of infection.
Important changes in the endocrine system for anesthesiologist
- Diabetes increases the risk of wound infection.
Important changes in the musculoskeletal system for anesthesiologist
- Difficult cardiopulmonary resuscitation
- Increasing the duration of surgery
- Difficult mask intubation and ventilation
- Risk of rhabdomyolysis in a long surgery
- The need in long spinal and epidural needles
- Technical difficulties while making a local anesthesia and analgesia.
Obese patients belong to the high-risk group of severe post-surgical complications. The thing is that obesity is associated with many physiological changes that reduce adaptation capabilities of the body during surgery and post-surgical period.
That is why, to optimize surgical and post-surgery risks, a patient should be prepared for anesthesia by a high-qualified and skilled anesthesiologist, who has all the necessary equipment.