TY - JOUR
T1 - Regional anesthesia in adult patients with obesity
AU - Şalvız, Emine Aysu
N1 - Publisher Copyright:
© Copyright Anesthesiology and Reanimation Specialists’ Society. This journal published by Logos Medical Publishing. Licenced by Creative Commons Attribution 4.0 International (CC)
PY - 2021
Y1 - 2021
N2 - Obesity is one of the important public health concerns, and described as abnormal accumulation of fat. It is associated with cardiopulmonary physiological alterations and a number of comorbidities (obstructive sleep apnea, metabolic syndrome, coronary artery disease…). Not only surgical and anesthetic managements of obese patients are challenging but also their perioperative morbidity and mortality rates are higher. We, as anesthesiologists, face these patients at an increasing rate with time. Since we prefer regional anesthesia techniques to general anesthesia in appropriate surgery types; we would avoid airway manipulations, opioid consumption and surgery-related stress responses. Regional anesthesia techniques are attractive options; however, they have unique challenges such as requirement for special equipment, crucial positioning, multiple attempts at redirecting needle/catheter, difficulty in palpation of anatomical landmarks, and increased rate of failed blocks in patients with obesity. Ultrasound-guidance provides us visualization of anatomical structures, decreased rates of needle insertions, and orientations, procedural trauma, side effects/complications and increased rates of block success. This review focuses on the obesity-related comorbidities; possible problems occur during the performance of neuroaxial, upper extremity, lower extremity, thoracic and abdominal wall block techniques performed on obese patients; literature supported suggestions and the role of ultrasound to manage these situations.
AB - Obesity is one of the important public health concerns, and described as abnormal accumulation of fat. It is associated with cardiopulmonary physiological alterations and a number of comorbidities (obstructive sleep apnea, metabolic syndrome, coronary artery disease…). Not only surgical and anesthetic managements of obese patients are challenging but also their perioperative morbidity and mortality rates are higher. We, as anesthesiologists, face these patients at an increasing rate with time. Since we prefer regional anesthesia techniques to general anesthesia in appropriate surgery types; we would avoid airway manipulations, opioid consumption and surgery-related stress responses. Regional anesthesia techniques are attractive options; however, they have unique challenges such as requirement for special equipment, crucial positioning, multiple attempts at redirecting needle/catheter, difficulty in palpation of anatomical landmarks, and increased rate of failed blocks in patients with obesity. Ultrasound-guidance provides us visualization of anatomical structures, decreased rates of needle insertions, and orientations, procedural trauma, side effects/complications and increased rates of block success. This review focuses on the obesity-related comorbidities; possible problems occur during the performance of neuroaxial, upper extremity, lower extremity, thoracic and abdominal wall block techniques performed on obese patients; literature supported suggestions and the role of ultrasound to manage these situations.
KW - Body mass index
KW - Neuroaxial anesthesia
KW - Obesity
KW - Peripheral nerve blocks
KW - Regional anesthesia
UR - http://www.scopus.com/inward/record.url?scp=85112487587&partnerID=8YFLogxK
U2 - 10.5222/jarss.2020.65477
DO - 10.5222/jarss.2020.65477
M3 - Review article
AN - SCOPUS:85112487587
SN - 1300-0578
VL - 29
SP - 219
EP - 230
JO - Anestezi Dergisi
JF - Anestezi Dergisi
IS - 1
ER -