Strategies for managing oxygenation in obese patients undergoing laparoscopic surgery

Abstract

The worldwide trend toward increasing body mass index (BMI) has caused the anesthetic management of overweight, obese, and severely obese patients to become common. The increase in oxygen demand coupled with the anatomic and physiologic changes associated with excess adipose tissue make maintenance of oxygenation a major challenge during induction, maintenance and recovery from general anesthesia. It is crucial for anesthesiologists, surgeons and perioperative healthcare providers alike to have a thorough understanding of the impact of airway management and mechanical ventilation on the respiratory care of the obese in the immediate perioperative setting. In this manuscript we aim to discuss the consequences of obesity, particularly abdominal obesity, on respiratory physiology and provide suggestions on intraoperative ventilatory strategies to maintain oxygenation in the severely obese patient undergoing pneumoperitoneum.

Effects of Sevoflurane versus Propofol on Endogenous Nitric Oxide Metabolism during Laparoscopic Surgery

“…ey were escorted back to the ward after they fully recovered, cough and swallowing reflex recovered, hemodynamic indexes were stable, and muscle strength recovered. Pain rescue treatment plan: if the patient requires or VAS score is greater than or equal to 7 points, flurbiprofen axetil (KAIFEN) 50 mg intravenous drip, if necessary, can be repeated within 24 hours, record the use of analgesic [26,27].…”

Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case–control study

“…Excess fat tissue in the surgical region may increase the difficulty and duration of the procedure due to lack of adequate exposure of the surgical site [9]. Moreover, fat tissue has less vascularity and lower tissue oxygenation than muscle tissue [34], and the use of retractors to pull apart the paraspinal soft tissue may further decrease blood flow and oxygen tension in fat tissue [24,35,36]; this may increase the risk of tissue necrosis and dead space development following wound closure, which have been thought to contribute to the development of postoperative infections [37,38]. In addition, LMM fat infiltration has its own mechanism through which it increases the risk of SSI.…”

Roux-en-Y Gastric Bypass

“…Therapeutic failure in the treatment of obesity has contributed to an alarming and insidious increase in this condition (Nepal et al, 2015). The association between obesity and certain metabolic disorders leads to deterioration in quality of life and an increased risk of cardiovascular morbidity and mortality, thus increasing health-care expenditures and constituting a serious challenge for modern society (Ortiz et al, 2014). Studies have also noted an association between obesity and psychiatric comorbidities, which adds to both the health risks and the economic costs of the condition.…”

“…The inexorable global increase in obesity has become a worldwide concern of the highest magnitude (Nepal, Bhattarai, & Agustin, 2015; Ortiz, Vidal-Melo, & Walsh, 2014). Obesity produces cardiometabolic complications, known collectively as metabolic syndrome (MS; Lin, Liang, Liao, & Tsay, 2014).…”