OBEZ HASTALAR İÇİN GÜNÜBİRLİK ANESTEZİ UYGULAMALARI

Abstract

Standard operating room conditions may not be provided in areas where ambulatory anesthesia is applied. For this reason, the infrastructure of the center should be taken into account when evaluating obese patients. Obesity is not an independent risk factor. Accompanying comorbidities are decisive in the development of perioperative complications. Obese patients should be evaluated for cardiac, pulmonary, endocrine, and OSAS. Particular attention should be paid when evaluating morbidly obese (BMI> 40 kg / m2) patients. Comorbidities, not BMI alone, should be decisive in terms of suitability for outpatient surgery. Super morbid obese patients with BMI > 50 kg / m2 can be taken to selected ambulatory surgery if there is no accompanying comorbidity. No relationship was found between BMI and difficult airway. However, it was stated that difficult mask ventilation and intubation were found in patients with a high mallampati score and neck circumference >50 cm. Therefore, it may be helpful to look at the neck circumference of obese patients preoperatively. The drugs to be used should be adjusted according to the ideal body weight and used by titration. It is recommended to use wakefulness (BIS) monitoring methods when adjusting the anesthetic dose for obese patients. Non-opioid analgesia methods should be preferred. Opioids should be preferred as rescue analgesics. If possible, regional anesthesia and analgesia methods should be applied. Anatomical difficulties should be considered in regional anesthesia and analgesia applications. Hospitalization should be considered in surgeries longer than three hours. In surgeries longer than 6 hours, patients should be hospitalized.