Obesity Supine Death Syndrome: Reports of Two Morbidly Obese Patients

Perioperative management of the severely obese patient: a selective pathophysiological review

“…In 1979, this was reported by Tsueda et al as ''obesity supine death syndrome''. 103 Lateral tilt may be required to offset aorto-caval compression. It has also been shown that prolonged supine positioning in obese patients with OSA leads Perioperative care in severe obesity 987…”

Obesity supine death syndrome revisited

“…In the latest nationwide anti-TB drug resistance survey carried out in Colombia (2005), MDR-TB accounted for 2.4% of new cases (initial MDR-TB) and 31.4% of previously treated cases [2]. Colombia has 32 departments, 11,000 TB cases per year and three laboratories to perform drug susceptibility testing (DST).…”

“…This catastrophic phenomenon has been called the ''obesity supine death syndrome''. However, only two other cases of this condition have been previously reported [2], and therefore it remains relatively unfamiliar to most physicians. We recently managed a 44-yr-old male with a body mass index of 80 kg?m -2 who immediately developed severe hypoxaemia, seizures and cardiovascular collapse when placed in the supine position.…”

“…The underlying mechanism mainly involves the extrinsic compression of the thorax by the huge abdominal compartment, pushing the diaphragm upwards in the supine position. This may result in collapse of the small airways, an increase in the work of breathing [6], severe hypoxaemia [7,8] and depressed cardiac output [2,9].…”

Obstáculos diagnósticos e desafios terapêuticos no paciente obeso

“…Muitos desses indivíduos sentem-se mais confortáveis dormindo em decúbito elevado ou em uma poltrona, negando sintomas de ortopnéia ou dispnéia paroxística noturna. Solicitar ao paciente que caminhe pelo corredor pode revelar uma tolerância ao exercício extremamente reduzida e assumir a posição supina pode produzir ortopnéia significativa e mesmo parada cardiorrespiratória (70). A flexão da cabeça em pacientes muito obesos, com depósitos de tecido adiposo em região cervical e submentoniana pode levar à obstrução da via aérea superior e parada respiratória.…”