Varbanova Marina, Maggard Brittany, Lenhardt Rainer
Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, United States.
International Society for the Care of the Obese Patient, University of Louisville, Louisville, Kentucky, United States.
Saudi J Anaesth. 2022 Jul-Sep;16(3):287-298. doi: 10.4103/sja.sja_140_22. Epub 2022 Jun 20.
The prevalence of obesity has tripled worldwide over the past four decades. The United States has the highest rates of obesity, with 88% of the population being overweight and 36% obese. The UK has the sixth highest prevalence of obesity. The problem of obesity is not isolated to the developed world and has increasingly become an issue in the developing world as well. Obesity carries an increased risk of many serious diseases and health conditions, including type 2 diabetes, heart disease, stroke, sleep apnea, and certain cancers. Our ability to take care of this population safely throughout the perioperative period begins with a thorough and in-depth preoperative assessment and meticulous preparation. The preoperative assessment begins with being able to identify patients who suffer from obesity by using diagnostic criteria and, furthermore, being able to identify patients whose obesity is causing pathologic and physiologic changes. A detailed and thorough anesthesia assessment should be performed, and the anesthesia plan individualized and tailored to the specific patient's risk factors and comorbidities. The important components of the preoperative anesthesia assessment and patient preparation in the patient suffering from obesity include history and physical examination, airway assessment, medical comorbidities evaluation, functional status determination, risk assessment, preoperative testing, current weight loss medication, and review of any prior weight loss surgeries and their implications on the upcoming anesthetic. The preoperative evaluation of this population should occur with sufficient time before the planned operation to allow for modifications of the preoperative management without needing to delay surgery as the perioperative management of patients suffering from obesity presents significant practical and organizational challenges.
在过去四十年间，全球肥胖症患病率增长了两倍。美国的肥胖率最高，88%的人口超重，36%的人口肥胖。英国的肥胖症患病率位居第六。肥胖问题并非发达国家独有，在发展中国家也日益成为一个问题。肥胖会增加许多严重疾病和健康状况的风险，包括2型糖尿病、心脏病、中风、睡眠呼吸暂停和某些癌症。我们在围手术期安全照料这一人群的能力始于全面深入的术前评估和精心准备。术前评估首先要能够依据诊断标准识别出肥胖患者，进而识别出肥胖正在引发病理和生理变化的患者。应进行详细全面的麻醉评估，并根据特定患者的风险因素和合并症制定个性化的麻醉方案。肥胖患者术前麻醉评估及患者准备的重要组成部分包括病史和体格检查、气道评估、内科合并症评估、功能状态测定、风险评估、术前检查、当前的减肥药物，以及回顾既往任何减肥手术及其对即将进行的麻醉的影响。对这一人群的术前评估应在计划手术前有足够时间进行，以便在无需推迟手术的情况下对术前管理进行调整，因为肥胖患者的围手术期管理面临重大的实际和组织挑战。
