RESUMENLa obesidad es una epidemia a nivel mundial, con más de 2.000 millones de adultos con sobrepeso u obesidad, por lo que cada vez es más probable enfrentarse a una embarazada obesa en la práctica clínica del equipo obstétrico. La obesidad incrementa los cambios fisiológicos del embarazo a nivel cardiovascular, respiratorio, metabólico y gastrointestinal, lo que tiene implicancias clínicas que aumentan los costos en salud y la morbimortalidad materna y fetal. Las embarazadas obesas son un constante desafío para el equipo obstétrico, anestesiológico y de salud, debiendo ser enfrentadas de forma multidisciplinaria para la obtención de mejores resultados obstétricos y perinatales. El anestesiólogo debe tener especial cuidado en el manejo analgésico del trabajo de parto y en la técnica anestésica para la operación cesárea. El objetivo central de la siguiente revisión es explicar, analizar y desarrollar las principales implicancias anestésicas a las cuales se ve enfrentado el especialista en una embarazada obesa. SUMMARYObesity is a global epidemic, with more than 2,000 million overweight or obese adults, so it is very likely to have an obese pregnant in the clinical practice of the anesthesiologist. Obesity increases the physiological changes of pregnancy in the cardiovascular, respiratory, metabolic and gastrointestinal system, which has clinical implications that increase health care costs and maternal and fetal morbidity and mortality. Obese pregnant are a constant challenge for the obstetric, anesthesiology and health team, and must be considerate in a multidisciplinary way to obtain better maternal and perinatal outcomes. The anesthesiologist should take special care in the labor analgesia and anesthetic technique for caesarean section. The focus of the following review is to present and develop the main anesthetic implications to which the anesthesiologist is confronted in obese pregnant patient.
Routine preoperative testing in elective surgery: what is the evidence? Any patient, who is undergoing a surgical or invasive procedure, requiring anesthesia or sedation, needs a preoperative evaluation. This is essential in any type of surgical procedure. Most of the times, clinical evaluation is sufficient to establish perioperative as well as patient's risk factors. Some of them may be modified during the period close to the intervention, without supplementary testing or consultation to others specialists. Currently, the tendency of specialists is request "routine preoperative testing" sometimes without a previous analysis of the clinical history and physical examination. It has been shown that a healthy young patient, undergoing elective surgery, does not need any test before surgery. Preoperative tests increases health costs and don't significantly change perioperative patient's morbidity and mortality. Tests such as chest X-ray, electrocardiogram, hematocrit/hemoglobin, coagulation test, platelet count, blood glucose and pregnancy tests have precise indications and should not routinely be requested to all the surgical population.
Perioperative management in patients with thyroid disorders and chronic glucocorticoid therapyThyroid disorders and chronic use of corticosteroids are common in the surgical population, so is necessary an appropriate perioperative management of these patients. There is no contraindication for elective surgery in patients with asymptomatic hypothyroidism and good control, it is not necessary to maintain the levothyroxine dose the day of surgery, due to the pharmacokinetic properties of the drug. If hypothyroid patients are symptomatic and/or have not reached the euthyroid phase, should be treated and compensated prior to the elective surgical procedure. Patients with hyperthyroidism should keep their antithyroid treatment including the day of surgery. The symptomatic and/or decompensated hyperthyroidism have an increased risk of developing a thyroid storm, so no elective surgery is recommended in these patients, which should be conducted once achieved an euthyroid state. A strict monitoring in the postoperative period is key to prevent complications. Chronic glucocorticoid use is common. In these patients there is risk of developing acute adrenal insufficiency by surgical stress, so before surgery (elective or emergency) it is necessary to supplement with exogenous corticosteroid dose dependent on the type of surgical procedure performed.resumen Los trastornos tiroideos y el uso crónico de corticoides son frecuentes en la población quirúrgica, por lo que es necesario un manejo perioperatorio adecuado en este tipo de pacientes. no existe contraindicación para una cirugía electiva en pacientes con hipotiroidismo asintomáticos y buen control, no siendo necesario
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