Friday, September 20, 2013

DIFFICULTIES FACED BY ANAESTHESIOLOGIST DUE TO OBESE PATIENTS

Obesity is excess body fat resulting in impairment of health of many in the present era.The body cannot store proteins and carbohydrates.So when a person continues to eat more and more,excess proteins and carbohydrates are converted into fat and deposited at various places like waist,thighs,abdomen etc.in the body. An imbalance between energy intake and  expenditure causes obesity. Obesity is defined as a bodyweight 20% or more above the ideal body weight.


The illnesses associated with obesity are Type 2 Diabetes, Obstructive Sleep Apnea, hypertension and cardiovascular disease  which make the treatment of any elective and emergency procedure/surgery extremely difficult and risky.

Obstructive Sleep Apnea (OSA) can result in decreased airflow and oxygen in patients receiving even minimal amounts of sedation. 
 Anesthesiologists have to anticipate these difficulties, prepare for them and counsel patients regarding potential complications.This requires the employment of anaesthesia techniques that are familiar,reproducible and safe all over the world, even though each patient should be treated as a individual case.

There should be an efficient anaesthesia team with experienced head leading it.There should be well equipped ICU for smooth post anaesthesia care.




IV CANNULATION:As you may observe in below picture,it is easy to insert iv cannula in a healthy ,non-obese person as veins are clearly visible.In the following picture you may find that the iv cannulation is difficult due to non-visibility of veins in obese patients.

We have to insert the longer i.v catheter into Internal jugular vein(IJV)  at the neck under ultrasound guidance.Once i.v access is achieved,the first safety precaution is taken care of. 



INTUBATION:To facilitate general anaesthesia, endo-tracheal intubation  is performed and easy to do in non-obese persons.
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We have to follow special techniques like fibre optic intubation in awake/light sedation for succesful intubation and maintenance of general anaesthesia for obese patients.


RECOVERY FROM ANAESTHESIA AFTER SURGERY:
We should be very careful to awaken the patient from anaesthesia after the surgery due to associated lung and airway problems making him prone to snoring/airway collapse if proper precautions are not followed.He should be fully responsive,able to follow our commands,able to lift head/arms against gravity, etc.After removing the endo-tracheal tube,he is placed in head up position and CPAP mask is attached with oxygen support.
LESSON OF THE DAY:REDUCE WEIGHT AS SOON AS POSSIBLE THROUGH DISCIPLINED LIFE STYLE.LIFE IS EASY DONT MAKE IT COMPLICATED.

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