Obesity in anaesthesia and intensive care

Abstract

Adams and Murphy Table 1 Medical and surgical conditions associated with obesity Category Cardiovascular disease Respiratory disease Endocrine disease Gastrointestinal disease Genitourinary Malignancy Musculoskeletal Examples Sudden (cardiac) death; obesity cardiomyopathy; hypertension; ischaemic heart disease; hyperlipidaemia; cor pulmonale; cerebrovascular disease; peripheral vascular disease; varicose veins; deep-vein thrombosis and pulmonary embolism Restrictive lung disease; obstructive sleep apnoea; obesity hypoventilation syndrome Diabetes mellitus; Cushing's disease; hypothyroidism; infertility Hiatus hernia; gallstones; inguinal hernia Menstrual abnormalities; female urinary incontinence; renal calculi Breast, prostate, colorectal, cervical and endometrial cancer Osteoarthritis of weight-bearing joints, back pain Obese, anaesthetized

A Model of the Effects of Fluid Variation due to Body Position on Cheyne–Stokes Respiration

“…Frequently in the literature, a range of 'average' mass values for males and females are provided, however for this thesis, 78 kg and 61 kg are chosen to be the ideal mass for males and females respectively [17]. Non-obese individuals contain anywhere from 75 mL to 86 mL of blood per kg [3,5,46]. Throughout this thesis, a value of 75 mL/kg of blood will be used.…”

“…It is known that the total blood volume in obese individuals increases on a volume/mass basis and ideal mass mL kg × (20 − 30)% = excess mass mL kg (4.1) [3,4]. This means that we must account for the excess blood found in fat tissues [4].…”

Morbid Obesity and Optimization of Preoperative Fluid Therapy

“…infusion of colloid fluids (Volulyte™, Fresenius Kabi Ab, Sweden) 6 ml/ kg of the calculated ideal body weight. A rough approximation of ideal body weight was calculated as the height in cm minus 100 in both genders (10). No other i.v.…”

“…However, RWL can expose MO to preoperative hypovolemia (8). In addition, cardiac involvement, including impaired relaxation and compliance of the left ventricle, is common in obesity of long duration (8)(9)(10)(11). Hence, fluid administration in morbidly obese patients is challenging and requires caution throughout the perioperative course, in order to avoid excessive rehydration (12)(13)(14).…”

Obesity and dentistry: a growing problem

“…37 Airway management for obese patients is also potentially more complicated than for the non-obese. 38 'Intramuscular' injections in an obese patient's thigh or buttock are more likely to be into fat, which has a relatively poor blood supply, leading to unpredictable therapeutic effects. Also, dosages for many drugs are weight-based.…”