Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Mar 2011
ReviewAnaesthesia for adults undergoing non-bariatric surgery.
Obesity is a worldwide epidemic with increasing importance in both industrialised and developing countries. Anaesthesiologists will be increasingly challenged by the care for morbidly and super-obese patients. ⋯ Careful preoxygenation, special positioning, adequate monitoring and adapted intra-operative ventilation are key issues for a successful perioperative care. While co-morbidities are frequent in the obese, overall morbidity and mortality up to a body mass index (BMI) < or = 40 kg m(-2) are not significantly increased compared with lean patients.
-
The steady rise in obesity observed in the recent years, coupled with its associated co-morbidities, suggests that clinicians will encounter obese patients with increasing frequency in their daily practice. Unfortunately, obese subjects are often excluded from clinical trials during the drug development process. ⋯ This review provides a pragmatic approach to the pharmacokinetic considerations that should guide drug administration. We hereby offer a systematic approach to dosing scalars, followed by an analysis of the factors affecting pharmacokinetics in obesity, and provide a detailed discussion on the single most commonly used pharmacological agents in anaesthesia.
-
Best Pract Res Clin Anaesthesiol · Mar 2011
ReviewRegional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance.
Obesity is associated with a number of anaesthetic-related risks. Regional anaesthesia offers many potential advantages for the obese surgical patient. ⋯ Ultrasound guidance may aid the regional anaesthesia practitioner with direct visualisation of underlying anatomic structures and real-time needle direction. Further research is needed to determine optimal regional anaesthesia techniques, local anaesthetic dosage and perioperative outcomes in obese patients.
-
Best Pract Res Clin Anaesthesiol · Mar 2011
ReviewThe epidemiology and aetiology of obesity: a global challenge.
Positive energy imbalance Energy imbalance leads to obesity. A majority of the US population is overweight, a third obese and nearly 5% morbidly obese. In the developing world, this problem continues to evolve in an rapid manner, creating challenges for already burdened health systems. ⋯ Factors ranging from the availability of calorie-dense foods, decreased time spent in physical activities, technologically assisted household chores to time spent watching television, all have some contribution to the problem. Much more needs to be done to control this obesity epidemic, both from a public health as well as a communal-expense perspective. Forced misuse of economic resources and wasted potential lives should drive a better coordinated effort to control what could possibly be the biggest health challenge of the 21st century.
-
The incidence of childhood obesity ranges today from approximately 8% to 17%, and is an increasing issue in developed and developing countries. This disease will become increasingly significant in paediatric anaesthesia. ⋯ This review covers current definition and some epidemiology of childhood obesity. It summarises potential co-morbidities and provides details for preoperative evaluation, anaesthetic management and prevention of perioperative complications.