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Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54(04): 242-254
DOI: 10.1055/a-0636-2782
Topthema
Georg Thieme Verlag KG Stuttgart · New York

Anästhesie bei Erwachsenen mit Adipositas

Anaesthesia in Adult Patients with Obesity
Axel Fudickar
,
Berthold Bein
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Publication History

Publication Date:
12 April 2019 (online)

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Zusammenfassung

Die Prävalenz der Adipositas hat in den letzten 10 Jahren weltweit erheblich zugenommen – deshalb wird die perioperative Versorgung auch extrem adipöser Patienten immer häufiger notwendig werden. Dies schließt medizinische, technische und organisatorische Aspekte ein. Dieser Beitrag fasst neue Erkenntnisse und Empfehlungen zur Anästhesie bei Adipositas zusammen.

Abstract

The prevalence of obesity has substantially increased worldwide during the last ten years. Hence, more anaesthetic procedures will be performed in obese patients in the future and more hospitals have to be prepared for the perioperative treatment of extremely obese patients including medical, technical and organisational issues. These include not only the management of the perioperative problems of adiposity, but also of its numerous concomitant diseases. Besides hyperlipidemia, diabetes mellitus, arterial hypertension and coronary heart disease, the obstructive sleep-apnea syndrome (OSAS) challenges the available equipment and the staff involved. Airway and breathing problems are very frequent and regional anaesthesia should be preferred. If general anaesthesia is indicated, short acting drugs like desflurane or remifentanil are recommended. Preoxygenation is improved by continuous positive airway pressure (CPAP). In this educational review, a summary of the currently known facts regarding anaesthesia in obese patients is outlined together with future perspectives. Regional anaesthesia is also recommended for postoperative pain therapy.

Kernaussagen

  • Die Prävalenz der Adipositas hat in den letzten 10 Jahren auch in Deutschland weiter zugenommen.

  • Hypertonie, Fettstoffwechselstörungen, Diabetes mellitus, kardiovaskuläre Erkrankungen und Schlafapnoe-Syndrom sind Folge- und Begleiterkrankungen der Adipositas.

  • Die perioperative Betreuung adipöser Patienten erfordert spezielle räumliche, apparative und personelle Voraussetzungen.

  • Probleme mit Atemwegsmanagement, Atmung und Monitoring sind bei Adipositas relativ häufig.

  • Regionalanästhesiologische Verfahren sollten bevorzugt eingesetzt werden.

  • Kurzwirksame Substanzen wie Desfluran und Remifentanil sind zu bevorzugen.

  • Die Präoxygenierung wird durch umgekehrte Trendelenburg-Lagerung und Unterstützung der Atmung mit kontinuierlichem positivem Atemwegsdruck effektiver.

  • Auch in der postoperativen Schmerztherapie sind Regionalanästhesieverfahren zu bevorzugen.

Schlüsselwörter

Adipositas - Anästhesie - Schlafapnoe-Syndrom

Key words

obesity - anaesthesia - obstructive sleep apnea syndrome
 

  • Literatur

  • 1 De Jong A, Verzilli D, Geniez M. et al. [Why is the morbidly obese patient at high risk of anesthetic complications?]. Presse Med 2018; 47: 453-463
    CrossrefPubMedGoogle Scholar
  • 2 Robert Koch-Institut. Übergewicht und Adipositas, 2018. Im Internet: http://www.rki.de/DE/Content/Gesundheitsmonitoring/Themen/Uebergewicht_Adipositas/Uebergewicht_Adipositas_node.html Stand: 08.01.2019
    PubMedGoogle Scholar
  • 3 Chau EH, Lam D, Wong J. et al. Obesity hypoventilation syndrome: a review of epidemiology, pathophysiology, and perioperative considerations. Anesthesiology 2012; 117: 188-205
    CrossrefPubMedGoogle Scholar
  • 4 Nightingale CE, Margarson MP, Shearer E. et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015; 70: 859-876
    CrossrefPubMedGoogle Scholar
  • 5 Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev 2013; 93: 359-404
    CrossrefPubMedGoogle Scholar
  • 6 Ortiz VE, Kwo J. Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiol 2015; 15: 97
    CrossrefPubMedGoogle Scholar
  • 7 Taylor VH, McIntyre RS, Remington G. et al. Beyond pharmacotherapy: understanding the links between obesity and chronic mental illness. Can J Psychiatry 2012; 57: 5-12
    CrossrefPubMedGoogle Scholar
  • 8 Gould MK, Garcia DA, Wren SM. et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e227S-e277S
    CrossrefPubMedGoogle Scholar
  • 9 Revelo XS, Luck H, Winer S. et al. Morphological and inflammatory changes in visceral adipose tissue during obesity. Endocr Pathol 2014; 25: 93-101
    CrossrefPubMedGoogle Scholar
  • 10 Bein B, Hocker J, Fudickar A. et al. [Anaesthesia management of the obese patient]. Anasthesiol Intensivmed Notfallmed Schmerzther 2009; 44: 600-608 quiz 610
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Lemanu DP, Srinivasa S, Singh PP. et al. Optimizing perioperative care in bariatric surgery patients. Obes Surg 2012; 22: 979-990
    CrossrefPubMedGoogle Scholar
  • 12 Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg 2013; 23: 2050-2057
    CrossrefPubMedGoogle Scholar
  • 13 Joshi GP, Ankichetty SP, Gan TJ. et al. Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesth Analg 2012; 115: 1060-1068
    CrossrefPubMedGoogle Scholar
  • 14 Mechanick JI, Youdim A, Jones DB. et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient – 2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013; 9: 159-191
    CrossrefPubMedGoogle Scholar
  • 15 Ingrande J, Brodsky JB, Lemmens HJ. Regional anesthesia and obesity. Curr Opin Anaesthesiol 2009; 22: 683-686
    CrossrefPubMedGoogle Scholar
  • 16 Futier E, Constantin JM, Pelosi P. et al. Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Anesthesiology 2011; 114: 1354-1363
    CrossrefPubMedGoogle Scholar
  • 17 Freid EB. The rapid sequence induction revisited: obesity and sleep apnea syndrome. Anesthesiol Clin North America 2005; 23: 551-564 viii
    CrossrefPubMedGoogle Scholar
  • 18 Pandit JJ, Andrade J, Bogod DG. et al. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods and analysis of data. Anaesthesia 2014; 69: 1078-1088
    CrossrefPubMedGoogle Scholar
  • 19 Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth 2010; 105 (Suppl. 01) i16-i23
    CrossrefPubMedGoogle Scholar
  • 20 Jaber S, De Jong A, Castagnoli A. et al. Non-invasive ventilation after surgery. Ann Fr Anesth Reanim 2014; 33: 487-491
    CrossrefPubMedGoogle Scholar