Anesthesia Notes: Obesity & Anesthesia
Obesity significantly impacts anesthetic management and perioperative care. Patients with obesity present unique challenges due to anatomical, physiological, and pharmacological considerations. These include difficult airway management, altered respiratory mechanics, increased risk of hypoventilation and obstructive sleep apnea (OSA), and higher incidence of comorbidities like diabetes and cardiovascular disease.
During anesthesia, drug dosing must be carefully calculated based on ideal body weight (IBW), lean body weight (LBW), or adjusted body weight (ABW) to avoid overdose or underdose, as distribution, metabolism, and clearance may be affected. Induction and maintenance of anesthesia require close monitoring, especially with volatile agents and opioids, to prevent respiratory depression.
Airway assessment and preparation are critical due to a higher risk of difficult intubation. Regional anesthesia can be advantageous when feasible, though technical difficulties may arise. Postoperatively, patients with obesity are at increased risk for respiratory complications, wound infections, thromboembolic events, and prolonged recovery. Multimodal analgesia and early mobilization are essential to optimize outcomes.
Proper planning, equipment readiness, and a multidisciplinary approach are vital to safely manage obese patients undergoing anesthesia.
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