Hashim Ahmed, Sedky Mostafa K, Masood Waniyah, Shehata Islam M, Kaye Alan D
Department of Anesthesia, Critical Care, and Pain Management, Faculty of Medicine, Ain Shams University (ASU), Cairo, Egypt.
Department of Surgery King, Salman International University, Mostafa, El Tor, South Sinai, Egypt.
Saudi J Anaesth. 2022 Oct-Dec;16(4):444-451. doi: 10.4103/sja.sja_469_22. Epub 2022 Sep 3.
Obesity in the pediatric population is considered a growing problem. It is likely that there will be a significant impact related to obesity on the health of future generations. Obesity has increased the incidence of a spectrum of diseases ranging from microvascular complications over the retina and peripheral nerves to an increased incidence of cancer. We have conducted an electronic search in MEDLINE, PubMed, ISI Web of Science, and Scopus scientific databases targeting studies published between 2000 till 2019. Several modalities have shown a wide spectrum of the effectiveness of weight control among adolescents. Despite achieving short-term success among obese adolescents, maintaining such change is challenging. The emergence of metabolic or bariatric surgeries has opened the door for long-term control over weight gain with considerable remission of unfavorable metabolic mediated or modulated effects associated with obesity such as diabetes mellitus and hypertension. The most commonly practiced metabolic surgery among adolescents is sleeve gastrectomy which is associated with comparable weight and metabolic control and a lesser risk of complication. Anesthesia is considered a major challenge among the pediatric population, especially those with significant obesity. Preoperative evaluation is always warranted to exclude and manage different associated comorbidities. The anesthetic challenges associated with pediatric obesity begin with intubation. Maintenance and emergence from anesthesia along with postoperative antiemetics and analgesia can pose additional challenges. Managing the postoperative period is considered a cornerstone in the early detection and management of any postoperative complication. Especially those complications related to the metabolic and nutritional aspects of the bariatric surgery. Finally, despite being a valuable option in managing obesity, bariatric surgery in adolescents comes with significant anesthetic challenges that need to be consistently evaluated and managed.
儿科人群中的肥胖被认为是一个日益严重的问题。肥胖很可能会对后代的健康产生重大影响。肥胖增加了一系列疾病的发病率，从视网膜和周围神经的微血管并发症到癌症发病率的上升。我们在MEDLINE、PubMed、ISI科学网和Scopus科学数据库中进行了电子检索，以查找2000年至2019年发表的研究。有几种方法已显示出在青少年体重控制方面具有广泛的有效性。尽管肥胖青少年在短期内取得了成功，但维持这种变化具有挑战性。代谢或减重手术的出现为长期控制体重增加打开了大门，同时与肥胖相关的不利代谢介导或调节效应（如糖尿病和高血压）有相当程度的缓解。青少年中最常用的代谢手术是袖状胃切除术，它与相当的体重和代谢控制以及较低的并发症风险相关。麻醉被认为是儿科人群中的一项重大挑战，尤其是那些严重肥胖的儿童。术前评估总是必要的，以排除和管理不同的相关合并症。与小儿肥胖相关的麻醉挑战始于插管。麻醉的维持和苏醒以及术后的止吐和镇痛可能会带来额外的挑战。管理术后阶段被认为是早期发现和管理任何术后并发症的基石。特别是那些与减重手术的代谢和营养方面相关的并发症。最后，尽管减重手术在治疗肥胖方面是一个有价值的选择，但青少年减重手术伴随着重大的麻醉挑战，需要持续评估和管理。
