肥胖症手术患者的麻醉管理：瑞士一家机构的两年经验
Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland.
作者信息
Lindauer Bastian, Steurer Marc P, Müller Markus K, Dullenkopf Alexander
机构信息
Department of Anesthesia and Intensive Care, Kantonsspital Frauenfeld, Pfaffenholzstrasse, 48501 Frauenfeld, Switzerland.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA.
出版信息
BMC Anesthesiol. 2014 Dec 18;14:125. doi: 10.1186/1471-2253-14-125. eCollection 2014.
BACKGROUND
In the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program.
METHODS
The perioperative approach was established together with all relevant disciplines. Pertinent topics for the anesthesiologists were; successful airway management, indications for more invasive monitoring, and the planning of the postoperative period and deposition. This retrospective analysis was approved by the local ethics committee. Data are mean [SD].
RESULTS
182 bariatric surgical procedures were performed (147 gastric bypass procedures (GBP; 146 (99.3%) performed laparascopically). GBP patients were 43 [10] years old, 78% female, BMI 45 [7] kg/m(2), 73% ASA physical status of 2. 42 patients (28.6%) presented with obstructive sleep apnea syndrome. 117 GBP (79.6%) patients were intubated conventionally by direct laryngoscopy (one converted to fiber-optic intubation, one aspiration of gastric contents). 32 patients (21.8%) required an arterial line, 10 patients (6.8%) a central venous line. Induction lasted 25 [16] min, the procedure itself 138 [42] min. No blood products were required. Two patients (1.4%) presented with hypothermia (<35 °C) at the end of their case. The emergence period lasted 17 [9] min. Postoperatively, 32 patients (21.8%) were transferred to the ICU (one ventilated). The other patients spent 4.1 [0.7] h in the post anesthesia care unit. 15 patients (10.2%) required take backs for surgical revision (two laparotomies).
CONCLUSIONS
The physiology and anatomy of bariatric patients demand a tailored approach from both the anesthesiologist and the perioperative team. The interaction of a multi-disciplinary team is key to achieving good outcomes and a low rate of complications.
TRIAL REGISTRATION
DRKS00005437 (date of registration 16(th) December 2013).
背景
在肥胖症手术麻醉领域，存在各种各样的建议，但对于此类患者围手术期管理缺乏普遍共识。我们概述了在引入肥胖症治疗项目后的头两年所获得的围手术期经验。
方法
围手术期方法是与所有相关学科共同确立的。麻醉医生关注的相关主题包括：成功的气道管理、更有创监测的指征以及术后阶段和处置的规划。这项回顾性分析获得了当地伦理委员会的批准。数据为均值[标准差]。
结果
共进行了182例肥胖症外科手术（147例胃旁路手术（GBP）；146例（99.3%）为腹腔镜手术）。GBP患者年龄为43[10]岁，78%为女性，体重指数为45[7]kg/m²，73%的美国麻醉医师协会（ASA）身体状况评分为2级。42例患者（28.6%）患有阻塞性睡眠呼吸暂停综合征。117例GBP患者（79.6%）通过直接喉镜常规插管（1例转为纤维支气管镜插管，1例发生胃内容物误吸）。32例患者（21.8%）需要置入动脉导管，10例患者（6.8%）需要置入中心静脉导管。诱导持续25[16]分钟，手术本身持续138[42]分钟。无需输注血液制品。2例患者（1.4%）在手术结束时出现体温过低（<35°C）。苏醒期持续17[9]分钟。术后，32例患者（21.8%）被转入重症监护病房（1例需要机械通气）。其他患者在麻醉后护理单元停留4.1[0.7]小时。15例患者（10.2%）因手术修正需要再次手术（2例开腹手术）。
结论
肥胖症患者的生理和解剖结构要求麻醉医生和围手术期团队采取量身定制的方法。多学科团队的协作是实现良好预后和低并发症发生率的关键。
试验注册
DRKS00005437（注册日期：2013年12月16日）
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