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Perioperative complications of obese patients

Kiss, Thomas; Bluth, Thomas; de Abreu, Marcelo Gama

Current Opinion in Critical Care: August 2016 - Volume 22 - Issue 4 - p 401–405
doi: 10.1097/MCC.0000000000000322
POSTOPERATIVE PROBLEMS: Edited by Paolo Pelosi and Marcelo Gama de Abreu

Purpose of review The perioperative care of obese patients can often be challenging, as the presence of comorbidities is common in this patient population. In this article, we present recent data on perioperative complications of obese patients and discuss relevant details for daily practice, including drug dosing, airway management, and mechanical ventilation.

Recent findings The volatile agent desflurane reduces extubation time, without major effects on postoperative anesthesia care unit discharge time, incidence of postoperative nausea and vomiting, or postoperative pain scores compared with other volatile anesthetics. Lean body weight is the most appropriate dosing scalar for most drugs used in anesthesia, including opioids and anesthetic induction agents. Compared with the operational theatre, airway complications occur 20-fold more often in the ICU, with poor outcome. Individual titration of positive end-expiratory pressure (PEEP) after lung recruitment improves gas exchange and lung mechanics intraoperatively, but data on patient outcome are lacking.

Summary Intensive care physicians who treat obese patients need to be trained in the management of the difficult airway. The application of PEEP and the use of recruitment maneuvers may lead to improved intraoperative oxygenation, but current data do not allow recommending the use of high PEEP combined with lung recruitment maneuvers in this population.

Department of Anesthesiology and Intensive Care, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany

Correspondence to Marcelo Gama de Abreu, Department of Anesthesiology and Intensive Care, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany. E-mail: mgabreu@uniklinikum-dresden.de

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