The obese patient undergoing nonbariatric surgery

Current Opinion in Anaesthesiology

Volumn 29, Issue 3, 2016, Pages 421-429

  Bluth, Thomas ^a   Pelosi, Paolo ^b   De Abreu, Marcelo Gama ^a  

^a UNIVERSITY HOSPITAL CARL GUSTAV CARUS   (Germany)

^b UNIVERSITY OF GENOA   (Italy)

Author keywords

Mechanical ventilation; Nonbariatric; Obese; Sleep apnea

Indexed keywords

OPIATE; ANALGESIC AGENT; ANESTHETIC AGENT;

AIRWAY DYNAMICS; ANALGESIA; ANESTHESIA INDUCTION; ARTIFICIAL VENTILATION; ASTHMA; BARIATRIC SURGERY; COMORBIDITY; CORONARY ARTERY ATHEROSCLEROSIS; DISEASE ASSOCIATION; EVIDENCE BASED PRACTICE; HEART FAILURE; HIGH RISK PATIENT; HUMAN; HYPERTENSION; LUNG COMPLICATION; META ANALYSIS (TOPIC); NONBARIATRIC SURGERY; OBESITY; OBESITY HYPOVENTILATION SYNDROME; PATHOPHYSIOLOGY; PATIENT MONITORING; PATIENT POSITIONING; PERIOPERATIVE PERIOD; POSITIVE END EXPIRATORY PRESSURE; POSTOPERATIVE CARE; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; PULMONARY HYPERTENSION; RANDOMIZED CONTROLLED TRIAL (TOPIC); REGIONAL ANESTHESIA; RESPIRATORY FUNCTION; REVIEW; SCORING SYSTEM; SLEEP DISORDERED BREATHING; STOP BANG SCORE; TIDAL VOLUME; HEMODYNAMIC MONITORING; PHYSIOLOGIC MONITORING; PRACTICE GUIDELINE; PROCEDURES; RISK ASSESSMENT;

ANALGESIA; ANALGESICS; ANESTHESIA, CONDUCTION; ANESTHETICS; ASTHMA; COMORBIDITY; CONTINUOUS POSITIVE AIRWAY PRESSURE; HEMODYNAMIC MONITORING; HUMANS; MONITORING, PHYSIOLOGIC; OBESITY; PERIOPERATIVE CARE; POSTOPERATIVE COMPLICATIONS; PRACTICE GUIDELINES AS TOPIC; RISK ASSESSMENT; SLEEP APNEA, OBSTRUCTIVE; SURGICAL PROCEDURES, OPERATIVE;

EID: 84961230854     PISSN: 09527907     EISSN: 14736500     Source Type: Journal    
DOI: 10.1097/ACO.0000000000000337     Document Type: Review

References (98)

1. WHO. An interactive surveillance tool for monitoring nutrition transition. Public Health Nutr 2006; 9:568-660.
2. The work of WHO in the Eastern Mediterranean Region. Annual Report of the regional Director 2008. Cairo WHO Reg Off East Mediterr. 2009
3. Doyle SL, Lysaght J, Reynolds JV. Obesity and postoperative complications in patients undergoing nonbariatric surgery. Obes Rev 2010; 11:875-886.
4. Pelosi P, Gregoretti C. Perioperative management of obese patients. Best Pract Res Clin Anaesthesiol 2010; 24:211-225.
5. Fernandez-Bustamante A, Hashimoto S, Serpa Neto A, et al. Perioperative lung protective ventilation in obese patients. BMC Anesthesiol 2015; 15:56.
6. Bein B, Scholz J. Anaesthesia for adults undergoing nonbariatric surgery. Best Pract Res Clin Anaesthesiol 2011; 25:37-51.
7. Abdullah HR, Chung F. Perioperative management for the obese outpatient. Curr Opin Anaesthesiol 2014; 27:576-582.
8. Moon TS, Joshi GP. Are morbidly obese patients suitable for ambulatory surgery? Curr Opin Anaesthesiol 2016; 29:141-145.
9. De Baerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesthesiol 2016; 29:119-128.
10. Mulier JP. Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome: mechanisms and alternative anesthesia strategies. Curr Opin Anaesthesiol 2016; 29:129-133.
11. Tsai A, Schumann R. Morbid obesity and perioperative complications. Curr Opin Anaesthesiol 2016; 29:103-108.
12. Poirier P, Alpert MA, Fleisher LA, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation 2009; 120:86-95.
13. Blüher M. Are there still healthy obese patients? Curr Opin Endocrinol Diabetes Obes 2012; 19:341-346.
14. Kim SH, Després J-P, Koh KK. Obesity and cardiovascular disease: friend or foe? Eur Heart J 2015. [Epub ahead of print]
15. Galic S, Oakhill JS, Steinberg GR. Adipose tissue as an endocrine organ. Mol Cell Endocrinol 2010; 316:129-139.
16. Littleton SW. Impact of obesity on respiratory function. Respirol Carlton Vic 2012; 17:43-49.
17. Garg R, Singh A, Prasad R, et al. A comparative study on the clinical and polysomnographic pattern of obstructive sleep apnea among obese and nonobese subjects. Ann Thorac Med 2012; 7:26-30.
18. Peromaa-Haavisto P, Tuomilehto H, Kössi J, et al. Prevalence of obstructive sleep apnoea among patients admitted for bariatric surgery. A prospective multicentre trial. Obes Surg 2015. [Epub ahead of print]
19. Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 2012; 8:199-207.
20. Cronin AJ, Keifer JC, Davies MF, et al. Postoperative sleep disturbance: influences of opioids and pain in humans. Sleep 2001; 24:39-44.
21. Rosenberg J. Sleep disturbances after noncardiac surgery. Sleep Med Rev 2001; 5:129-137.
22. Chung F, Nagappa M, Singh M, Mokhlesi B. CPAP in the perioperative setting: evidence of support. Chest 2015. [Epub ahead of print]. doi: 10.1378/chest.15-1777.
23. Hart N, Mandal S, Manuel A, et al. Obesity hypoventilation syndrome: does the current definition need revisiting? Thorax 2014; 69:83-84.
24. Tulaimat A, Littleton S. Defining obesity hypoventilation syndrome. Thorax 2014; 69:491-1491.
25. Povitz M, James MT, Pendharkar SR, et al. Prevalence of Sleep-disordered Breathing in Obese Patients with Chronic Hypoxemia. A Cross-Sectional Study. Ann Am Thorac Soc 2015; 12:921-927.
26. Hai F, Porhomayon J, Vermont L, et al. Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth 2014; 26:591-600.
27. Kaw R, Bhateja P, Paz Y, Mar H, et al. Postoperative complications in patients with unrecognized obesity hypoventilation syndrome undergoing elective noncardiac surgery. Chest 2015; 149:84-91.
28. Singh M, Liao P, Kobah S, et al. Proportion of surgical patients with undiagnosed obstructive sleep apnoea. Br J Anaesth 2013; 110:629-636.
29. Peters-Golden M, Swern A, Bird SS, et al. Influence of body mass index on the response to asthma controller agents. Eur Respir J 2006; 27:495-503.
30. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108:812-821.
31. Ong TH, Raudha S, Fook-Chong S, et al. Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath 2010; 14:371-376.
32. Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg 2013; 23:2050-2057.
33. Lockhart EM, Willingham MD, Abdallah AB, et al. Obstructive sleep apnea screening and postoperative mortality in a large surgical cohort. Sleep Med 2013; 14:407-415.
34. Dixon AE, Holguin F, Sood A, et al. An official American Thoracic Society Workshop report: obesity and asthma. Proc Am Thorac Soc 2010; 7:325-335.
35. Sideleva O, Suratt BT, Black KE, et al. Obesity and asthma: an inflammatory disease of adipose tissue not the airway. Am J Respir Crit Care Med 2012; 186:598-605.
36. Al-Alwan A, Bates JHT, Chapman DG, et al. The nonallergic asthma of obesity. A matter of distal lung compliance. Am J Respir Crit Care Med 2014; 189:1494-1502.
37. Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106:617-631.
38. Kheterpal S, Healy D, Aziz MF, et al. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology 2013; 119:1360-1369.
39. Leoni A, Arlati S, Ghisi D, et al. Difficult mask ventilation in obese patients: analysis of predictive factors. Minerva Anestesiol 2014; 80:149-157.
40. Cattano D, Katsiampoura A, Corso RM, et al. Predictive factors for difficult mask ventilation in the obese surgical population. F1000Res 2014; 3:239.
41. De Jong A, Molinari N, Pouzeratte Y, et al. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. Br J Anaesth 2015; 114:297-306.
42. Acar HV, Yarkan Uysal H, Kaya A, et al. Does the STOP-Bang, an obstructive sleep apnea screening tool, predict difficult intubation? Eur Rev Med Pharmacol Sci 2014; 18:1869-1874.
43. el-Ganzouri AR, McCarthy RJ, Tuman KJ, et al. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82:1197-1204.
44. Arné J, Descoins P, Fusciardi J, et al. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index. Br J Anaesth 1998; 80:140-146.
45. Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth 2014; 113:549-559.
46. Members of the Working Party. Nightingale CE, Margarson MP, et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015; 70:859-876.
47. Altermatt FR, Mun oz HR, Delfino AE, Cortinez LI. Preoxygenation in the obese patient: effects of position on tolerance to apnoea. Br J Anaesth 2005; 95:706-709.
48. Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology 2005; 102:1110-1115.
49. Valenza F, Vagginelli F, Tiby A, et al. Effects of the beach chair position, positive end-expiratory pressure, and pneumoperitoneum on respiratory function in morbidly obese patients during anesthesia and paralysis. Anesthesiology 2007; 107:725-732.
50. Collins JS, Lemmens HJM, Brodsky JB, et al. Laryngoscopy and morbid obesity: a comparison of the 'sniff and 'ramped' positions. Obes Surg 2004; 14:1171-1175.
51. Edmark L, Ostberg E, Scheer H, et al. Preserved oxygenation in obese patients receiving protective ventilation during laparoscopic surgery: a randomized controlled study. Acta Anaesthesiol Scand 2016; 60:26-35.
52. Harbut P, Gozdzik W, Stjernfalt E, et al. Continuous positive airway pressure/pressure support preoxygenation of morbidly obese patients. Acta Anaesthesiol Scand 2014; 58:675-680.
53. Futier E, Constantin J-M, Pelosi P, et al. Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Anesthesiology 2011; 114:1354-1363.
54. Freid EB. The rapid sequence induction revisited: obesity and sleep apnea syndrome. Anesthesiol Clin N Am 2005; 23:551-564.
55. Steier J, Lunt A, Hart N, et al. Observational study of the effect of obesity on lung volumes. Thorax 2014; 69:752-759.
56. Mahajan V, Hashmi J, Singh R, et al. Comparative evaluation of gastric pH and volume in morbidly obese and lean patients undergoing elective surgery and effect of aspiration prophylaxis. J Clin Anesth 2015; 27:396-400.
57. Juvin P, Fevre G, Merouche M, et al. Gastric residue is not more copious in obese patients. Anesth Analg 2001; 93:1621-1622.
58. Cook-Sather SD, Gallagher PR, Kruge LE, et al. Overweight/obesity and gastric fluid characteristics in pediatric day surgery: implications for fasting guidelines and pulmonary aspiration risk. Anesth Analg 2009; 109:727-736.
59. Taha SK, El-Khatib MF, Baraka AS, et al. Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction. Anaesthesia 2010; 65:358-361.
60. -1 ideal body weight of rocuronium. Eur J Anaesthesiol 2011; 28:609-610.
61. Bisschops MMA, Holleman C, Huitink JM. Can sugammadexsave a patient in a simulated 'cannot intubate, cannot ventilate' situation? Anaesthesia 2010; 65:936-941.
62. Andersen LH, Rovsing L, Olsen KS. GlideScope videolaryngoscope vs. Macintosh direct laryngoscope for intubation of morbidly obese patients: a randomized trial. Acta Anaesthesiol Scand 2011; 55:1090-1097.
63. Nicholson A, Cook TM, Smith AF, et al. Supraglottic airway devices versus tracheal intubation for airway management during general anaesthesia in obese patients. Cochrane Database Syst Rev 2013; 9:CD010105.
64. Aldenkortt M, Lysakowski C, Elia N, et al. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and metaanalysis. Br J Anaesth 2012; 109:493-502.
65. Jaber S, Coisel Y, Chanques G, et al. A multicentre observational study of intra-operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight. Anaesthesia 2012; 67:999-1008.
66. Lellouche F, Dionne S, Simard S, et al. High tidal volumes in mechanically ventilated patients increase organ dysfunction after cardiac surgery. Anesthesiology 2012; 116:1072-1082.
67. Serpa Neto A, Hemmes SNT, Barbas CSV, et al. Protective versus conventional ventilation for surgery: a systematic review and individual patient data meta-analysis. Anesthesiology 2015; 123:66-78.
68. Serpa Neto A, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 2012; 308:1651-1659.
69. Futier E, Constantin J-M, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med 2013; 369:428-437.
70. Severgnini P, Selmo G, Lanza C, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology 2013; 118:1307-1321.
71. Eriksen J, Andersen J, Rasmussen JP, Sørensen B. Effects of ventilation with large tidal volumes or positive end-expiratory pressure on cardiorespiratory function in anesthetized obese patients. Acta Anaesthesiol Scand 1978; 22:241-248.
72. Pelosi P, Ravagnan I, Giurati G, et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999; 91:1221-1231.
73. Reinius H, Jonsson L, Gustafsson S, et al. Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology 2009; 111:979-987.
74. Defresne AA, Hans GA, Goffin PJ, et al. Recruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study. Br J Anaesth 2014; 113:501-507.
75. Wang C, Zhao N, Wang W, et al. Intraoperative mechanical ventilation strategies for obese patients: a systematic review and network meta-analysis. Obes Rev 2015; 16:508-517.
76. Whalen FX, Gajic O, Thompson GB, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg 2006; 102:298-305.
77. Baltieri L, Santos LA, Rasera I, et al. Use of positive pressure in the bariatric surgery and effects on pulmonary function and prevalence of atelectasis: randomized and blinded clinical trial. Arq Bras Cir Dig 2014; 27 (Suppl 1): 26-30.
78. Pirrone M, Fisher D, Chipman D, et al. Recruitment maneuvers and positive end-expiratory pressure titration in morbidly obese ICU patients. Crit Care Med 2016; 44:300-307.
79. Ferrando C, Soro M, Canet J, et al. Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial. Trials 2015; 16:193.
80. PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology. Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet 2014; 384:495-503.
81. Bohm SH, Thamm OC, von Sandersleben A, et al. Alveolar recruitment strategy and high positive end-expiratory pressure levels do not affect hemodynamics in morbidly obese intravascular volume-loaded patients. Anesth Analg 2009; 109:160-163.
82. Canet J, Belda FJ. Perioperative hyperoxia: the debate is only getting started. Anesthesiology 2011; 114:1271-1273.
83. Staehr AK, Meyhoff CS, Rasmussen LS; PROXI Trial Group. Inspiratory oxygen fraction and postoperative complications in obese patients: a subgroup analysis of the PROXI trial. Anesthesiology 2011; 114:1313-1319.
84. Hedenstierna G. Oxygen and anesthesia: what lung do we deliver to the postoperative ward? Acta Anaesthesiol Scand 2012; 56:675-685.
85. Zoremba M, Kalmus G, Dette F, et al. Effect of intra-operative pressure support vs pressure controlled ventilation on oxygenation and lung function in moderately obese adults. Anaesthesia 2010; 65:124-129.
86. Pelosi P, Croci M, Calappi E, et al. Prone positioning improves pulmonary function in obese patients during general anesthesia. Anesth Analg 1996; 83:578-583.
87. Goucham AB, Coblijn UK, Hart-Sweet HB, et al. Routine postoperative monitoring after bariatric surgery in morbidly obese patients with severe obstructive sleep apnea: ICU admission is not necessary. Obes Surg 2015.
88. Hans GA, Lauwick S, Kaba A, et al. Postoperative respiratory problems in morbidly obese patients. Acta Anaesthesiol Belg 2009; 60:169-175.
89. Hollier CA, Harmer AR, Maxwell LJ, et al. Moderate concentrations of supplemental oxygen worsen hypercapnia in obesity hypoventilation syndrome: a randomised crossover study. Thorax 2014; 69:346-353.
90. Povitz M, Hanly PJ, Pendharkar SR, et al. Treatment of sleep disordered breathing liberates obese hypoxemic patients from oxygen. PloS One 2015; 10:e0140135.
91. Liao P, Luo Q, Elsaid H, et al. Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: a randomized controlled trial. Anesthesiology 2013; 119:837-847.
92. O'Gorman SM, Gay PC, Morgenthaler TI. Does autotitrating positive airway pressure therapy improve postoperative outcome in patients at risk for obstructive sleep apnea syndrome? A randomized controlled clinical trial. Chest 2013; 144:72-78.
93. Abdelsattar ZM, Hendren S, Wong SL, et al. The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep 2015; 38:1205-1210.
94. Taylor S, Kirton OC, Staff I, Kozol RA. Postoperative day one: a high risk period for respiratory events. Am J Surg 2005; 190:752-756.
95. Doufas AG, Tian L, Padrez KA, et al. Experimental pain and opioid analgesia in volunteers at high risk for obstructive sleep apnea. PloS One 2013; 8:e54807.
96. Cotter JT, Nielsen KC, Guller U, et al. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery: an analysis of 9, 342 blocks. Can J Anaesth J Can Anesth 2004; 51:810-816.
97. Bomberg H, Albert N, Schmitt K, et al. Obesity in regional anesthesia: a risk factor for peripheral catheter-related infections. Acta Anaesthesiol Scand 2015; 59:1038-1048.
98. Alvarez A, Singh PM, Sinha AC. Postoperative analgesia in morbid obesity. Obes Surg 2014; 24:652-659.