Regional Anesthesia in Adult Patients with Obesity

Obesity is one of the important public health concerns, and described as abnormal accumulationof fat. It is associated with cardiopulmonary physiological alterations and a number of comorbidities (obstructive sleep apnea, metabolic syndrome, coronary artery disease…). Not only surgical and anesthetic managements of obese patients are challenging but also their perioperativemorbidity and mortality rates are higher. We, as anesthesiologists, face these patients at anincreasing rate with time. Since we prefer regional anesthesia techniques to general anesthesiain appropriate surgery types; we would avoid airway manipulations, opioid consumption andsurgery-related stress responses. Regional anesthesia techniques are attractive options; however,they have unique challenges such as requirement for special equipment, crucial positioning,multiple attempts at redirecting needle/catheter, difficulty in palpation of anatomical landmarks,and increased rate of failed blocks in patients with obesity. Ultrasound-guidance provides usvisualization of anatomical structures, decreased rates of needle insertions, and orientations ,procedural trauma, side effects/complications and increased rates of block success. This reviewfocuses on the obesity-related comorbidities; possible problems occur during the performance ofneuroaxial, upper extremity, lower extremity, thoracic and abdominal wall block techniques performed on obese patients; literature supported suggestions and the role of ultrasound to managethese situations.

Erişkin Obez Hastalarda Rejyonal Anestezi

Obezite önemli halk sağlığı sorunlarından biridir ve anormal yağ birikimi olarak tarif edilmektedir. Kardiopulmoner fizyolojik değişiklikler ve çok sayıda yandaş hastalık (obstrüktif uyku apnesi, metabolik sendrom, koroner arter hastalığı…) ile ilişkilidir. Obez hastaların hem cerrahi ile anestezi yönetimleri zor hem de perioperatif morbidite ile mortalite oranları yüksektir. Anestezistler olarak bizler, bu hastalar ile zaman geçtikçe daha yüksek oranlarda karşılaşmaktayız. Uygun cerrahi tiplerinde, rejyonal anestezi tekniklerini genel anesteziye tercih ettiğimiz için hava yolu manipulasyonlarından, opioid tüketiminden ve cerrahiye bağlı stres yanıtlardan kaçınabilmekteyiz. Rejyonal anestezi teknikleri cazip seçeneklerdir; ancak onların da özellikle obezitesi olan hastalarda, özel ekipman ihtiyacı, zor pozisyonlama, zor anatomik işaret nokta palpasyonu, çok sayıda iğne/kateter yönlendirme ihtiyacı ve artmış oranda başarısız blok gibi kendilerine has problemleri mevcuttur. Ultrasonografi-rehberliği; anatomik yapıların görüntülenmesini, iğne giriş, yönlendirme, işlemsel travma, yan etki/komplikasyon oranlarının düşmesini ve blok başarısının artmasını sağlamaktadır. Bu derleme; obezite ilişkili yandaş hastalıklar, obez hastalarda nöroaksiyel, üst ekstremite, alt ekstremite, torasik ve abdominal blok teknik uygulamaları sırasında ortaya çıkan olası problemler, bu durumları yönetmede literatürde yer alan öneriler ve ultrasonografinin rolü üzerinde yoğunlaşmıştır

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