Hüseyin TOMAN, MESUT ERBAŞ, Muhammed Kasım ARIK, Hasan ŞAHİN, HASAN ALİ KİRAZ, TUNCER ŞİMŞEK, Faruk ÖZKUL, Tuğba DOĞU, Uğur ALTINIŞIK, Hatice Betül ALTINIŞIK

MORBİD, SÜPER VE SÜPER SÜPER OBEZ HASTALARDA LAPAROSKOPİK TÜP GASTREKTOMİ CERRAHİSİNDE ANESTEZİ DENEYİMLERİMİZ

Amaç: Klinik olarak vücut kitle indeksinin (VK) 30 kg m-2 üzerinde olması "obezite", 40 kg m-2 üzerinde olması "morbid obezite", 50 kg m-2den büyük olması "süper obezite", 60 kg m-2 den büyük olması ise "süper süper obezite" olarak tanımlanmaktadır. Anestezi yönetimi obezite cerrahisi geçirecek olgularda ventilasyon ve entübasyon güçlüğü, anestezik ilaç ve doz seçimi, sıvı yönetimi, postoperatif hava yolu güvenliği gibi nedenlerle önemlidir. Bu çalışmada Laparoskopik Tüp gastrektomi (LTG) yapılan morbid, süper ve süper süper obez hastalardaki anestezi deneyimlerimizi paylaşmayı amaçladık. Yöntem: Çalışma LTG cerrahisi geçiren 20 hastanın dosyalarının retrospektif olarak incelenmesi ile gerçekleştirildi. Anestezi indüksiyonunda hastalara, f entanil ideal vücut ağırlığına (VA) göre 1-2 µg kg-1, propof ol total vücut ağırlığına göre 1.5-2.5 mg kg-1 ve roküronyum VAya göre 0.6-0.8 mg kg-1 intravenöz verilerek, ters trendelenburg ve rampa pozisyonunda entübasyon gerçekleştirildi. damede desf luran ve remif entanil inf üzyon kullanıldı. Ekstübasyon öncesi rekruitment manevrası ve 3-4 mg kg-1 i.v. sugammadeks uygulandı. Bulgular: Kadın/Erkek (K/E) oranı 18/2, ortalama Vücut Kitle indeksi (VKİ) 51.4 kg m-2 idi, hastaların 11i morbid obez, 6sı süper obez, 3ü süper süper obezdi. ASA II/III/IV değerleri sırayla 1/13/6, mallampati skoruna II/III/IV sırayla 10/6/4 idi. Onüç hastaya STOP BANG anket yapıldı ve rampa pozisyonunda entübe edildi. Sonuç: LTG geçirecek olgularda iyi bir preoperatif hazırlığın, anestezi indüksiyonu ve idamesinde kısa etkili, düşük dozlarda anesteziklerin tercih edilmesinin, rampa pozisyonu, peroperatif PEEP uygulaması, yeterli analj ezi sağlanması, nöromüsküler bloğun sugammadeks ile antagonize edilmesinin postoperatif komplikasyonları önleyebileceği kanısındayız.

OUR ANESTHETIC EXPERIENCES WITH MORBIDLY, SUPER AND SUPER SUPER OBESE PATIENTS UNDERWENT LAPAROSCOPIC GASTRIC SLEEVE SURGERY

Obj ective: Obesity is clinically def ined with BMI (body mass index) greater than 30 kg m-2 and BMI over the 40 kg m-2 is def ined as "morbid obesity ", over the 50 kg m-2 BMI is def ined as "super obesity " and if BMI is more than 60 kg m-2 it is def ined as "super super obesity ". Anesthetic management is important because of the problems in cases undergoing bariatric surgery such as ventilation and intubation diff uculties, anesthetic drug and dose selection, f luid management and securing airway in postoperative period. In this study, we aimed to share our experiences with morbid, super and super super obese patients underwent laparoscopic gastric sleeve (LGS) surgery. Method: The study perf ormed by the retrospective analysis of 20 patients underwent LGS surgery. Fentanyl 1-2 µg kg-1 ideal body weight (IBW), propof ol 1.5-2.5 mg kg-1 total body weight and rocuronium 0.6-0.8 mg kg-1 IBW administered intravenously f or anesthesia induction, patients intubation was perf ormed in the reverse trendelenburg and the ramp position. Desf lurane and remif entanil inf usion are used f or maintenance. Recruitment maneuver and 3-4 mg kg-1 iv sugammadex used.bef ore the extubation. Results: The women-to-men ratio was 18/2, BMI was 51.4 kg m-2, and 11 were morbid obese, 6 were super obese, 3 were super super obese of the patients. ASA II/III/IV scores were 1/13/6 respectively. STOP BANG questionnaire was given to thirteen patients and intubation was perf ormed in the ramp position. Conclusion: We think making an optimal preoperative preparation, choosing short acting and low doses of intravenous anesthetics, putting patient in ramp position f or intubation, applying peroperative PEEP, providing adequate analgesia and antagonising neuromuscular block with sugammadex would prevent the postoperative complications in cases undergoing LGS surgery.

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