ARZU ESEN TEKELİ, Esra EKER, Mehmet Kadir BARTIN, Muzaffer Önder ÖNER

Anesthesia Management in Laparoscopic Sleeve Gastrectomy Cases

Obesity is a rapidly growing health condition worldwide and negatively affects the quality and duration of life. Anesthesia for morbidly obese patients is considered to be a real challenge to the anesthetist. In this study we aimed to evaluate difficult tracheal intubation and anesthesia management for obese patients. This study included 60 patients who had undergone laparascopic sleeve gastrectomy (LSG) between July 2012 and July 2017.We recorded gender, age, and body mass index (BMI) at the time of LSG, intraoperative incident, comorbidities, length of intensive care unit (ICU) admission. The relation of weight with difficult intubation was statistically significant, but it was not correlated with height and bod y mass index. Weight and BMI were found to have a statistically significant relationship with neck extension limitation. Difficult cases of intubation were seen mostly by 28% of patients. In this retrospective study, it was determined that laparoscopic sleeve gastrectomy and intubation difficulty was independent of body mass index. More extensive studies should be done to demonstrate the specific airway management and anesthesia of laparoscopic sleeve gastrectomy.

PDF

___

1. WHO | Obesity and overweight. WHO 2016.

2. Turkey Endocrinology and Metabolism Society of Obesity Diagnosis and Treatment Guide. Obesity, Dyslipidemia, Hypertension Working Group 2014; 1: 11- 5

3. Lukosiute A, Karmali A, Cousins JM. Anaesthetic Preparation of Obese Patients: Current Status on Optimal Work-up. Curr Obes Rep 2017; 6: 229- 237.

4. Akbas S, Ozkan AS. Comparison of effects of low-flow and normal-flow anesthesia on cerebral oxygenation and bispectral index in morbidly obese patients undergoing laparoscopic sleeve gastrectomy: a prospective, randomized clinical trial. Videosurgery Miniinv 2019; 14: 19-26.

5. Shimonov M, Schechter P, Boaz M, Waintrob R, Ezri T. Does Body Mass Index Reduction by Bariatric Surgery Affect Laryngoscopy Difficulty During Subsequent Anesthesia?Obes Surg 2016; 26: 2640-2647.

6. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105-1111.

7. Shiga T, Wajima Z, Inoue T, et al. Predicting difficult intubation in apparently normal patients. Anesthesiology 2005; 103: 429-437.

8. Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 2003; 97: 595-600.

9. Brodsky JB, Lemmens HJM, Brock-Utne JG, et al. Morbid obesity and tracheal intubation. Anesth Analg 2002; 94: 732- 736.

10. Elay G, Bahar I, Oksuz H. Youn bakımda hava yolu yönetimi. In: Nimet Senoglu (edt). Olgularala Yogun Bakım Protokolleri (1st ed). Ankara: Nobel Tıp Kitabevleri 2019; 45-57.

11. Lundstrøm LH, Møller AM, Rosenstock C, et al. High body mass index is a weak predictor for difficult and failed tracheal intubation. Anesthesiology 2009; 110: 266-274.

12. Dohrn N, Sommer T, Bisgaard J, Rønholm E, Larsen FJ. Difficult Tracheal Intubation in Obese Gastric Bypass patients. Obes Surg 2016; 26: 2640-2647.

13. Johnson BL, Blackhurst DW, Latham BB, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013; 216: 545-556.

14. Yska JP, van Roon EN, de Boer A, et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population-based cohort study in the United Kingdom. JAMA Surg. 2015; 150: 1-8.

15. Rao KVN, Dhatchinamoorthi D, Nandhakumar A, et al. Validity of thyromental height test asa predictor of difficult laryngoscopy:A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference,and neck extension.Indian J Anaesth 2018; 62: 603-608.