Postoperatives Management bei Patienten mit einem BMI > 40 kg / m²

Zusammenfassung

In der bariatrischen Chirurgie, speziell bei morbid-adipösen Patienten, kann es zu schwerwiegenden Komplikationen kommen. Neben chirurgischen Komplikationen können vorbestehende Erkrankungen während der peri- und postoperativen Phase exazerbieren. Bariatrische Patienten benötigen ein spezielles angepasstes Infusions- und Schmerzmanagement, die Therapie des Obesitas-Hypoventilationssyndroms, eine frühzeitige Mobilisierung und präventive Maßnahmen zur Verhinderung von Druckulzera. Eine besondere Herausforderung ist das frühzeitige Erkennen und Management der postoperativen abdominalen Sepsis (IAS) bevor es zum Organversagen kommt. Eine frühe und regelmäßige Mobilisation reduziert das Risiko für die Entstehung von Druckulzera, tiefer Beinvenenthrombosen, Resedierung, Schmerz, pulmonalen Atelektasen und Pneumonien. Zum Schutz des Personals ist es unumgänglich, spezielle Arbeitshilfen wie Spezialbetten sowie Hebe- und Transfervorrichtungen, bereitzustellen.

Abstract

Bariatric surgery, especially in the morbidly obese, can be associated with serious postoperative problems. Apart from surgical complications requiring reoperation, pre-existing disease can worsen during the postoperative period. Bariatric patients require particular therapeutic approaches such as adapted fluid and pain management, management of obstructive sleep apnoea-hypopnea, early ambulation and measures for preventing pressure ulcers. Another challenging issue is the early identification and management of postoperative intraabdominal sepsis (IAS) before the onset of organ dysfunction. Early and frequent ambulation is thought to reduce risk of pressure ulcers, deep vein thrombosis, resedation, pain, pneumonia and atelectasis. To prevent spine injury of health care workers it is necessary to provide appropriate support with special beds, lifting and transfer devices.

postoperatives Management - bariatrische Chirurgie - Besonderheiten

postoperative management - bariatric surgery - therapeutic approaches

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