Obese patient and anesthesia

Obesity (obesitas) is a condition characterized by weight gain caused by an increase in body fat (over 25% in men and over 30% in women) caused by hypertrophy or hyperplasia of the adipocytes (fat cells).
is caused by the increased supply of nutrients in relation to the body’s needs and the possibility of their consumption (burning).

The most commonly used indicator in everyday medical work and population studies to diagnose and assess the degree of is the body mass index (BMI), also known as the Quetelet index. We calculate it by dividing body weight (kg) by height squared (m2). According to the World Health Organization (WHO), in adults is diagnosed at a value of? 30.0 kg / m2. We consider the value within 19-24.9 to be normal, the patient’s body weight is normal. BMI over 40 according to the American wording is called morbid obesity. An obese patient is at risk of a greater number of intraoperative and postoperative complications. This is included, for example, in the operational risk scale developed by the Society of American Anasthesiologists, according to which a slim 45-year-old man who does not suffer from chronic diseases, e.g. bronchial asthma or arterial hypertension, receives the 1st degree of operational risk, and his peer weighing 20-30 kg more immediately receives the second degree on this scale. The scale has 5 degrees, the higher the grade, the higher the risk of surgery. Health problems in an obese patient on the operating table concern almost all organs. There is hypoxia in the respiratory system
(hypoxia) and an increase in carbon dioxide (hypercapnia). It is related to the structure of the upper respiratory tract (short, thick neck), the excess of soft tissues around the larynx and palate, and decreased ventilation of the chest associated with fat muscles and ribs.

Hypertension is very common in obese people, and conversely, weight loss quickly brings blood pressure to normal. A hiatal hernia often occurs in obese people, increasing the risk of aspiration during general anesthesia and the development of a very dangerous chemical pneumonia. The of anesthesia drugs is also different in obese people, a lot of drugs accumulate in adipose tissue, so the duration of general anesthesia is prolonged. Many surgical specialties currently set the weight limit of a patient prepared for surgery, e.g. orthopedists, neurologists or vascular surgeons, categorically recommend weight reduction. So it is worth fighting the extra pounds, which – as you can see – make everyday life difficult, but can also pose a threat to health and life.