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肥胖女性的围手术期麻醉管理。

Peri-operative anaesthetic management of women with obesity.

机构信息

Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.

Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA. Electronic address: https://twitter.com/ashrafhabib5.

出版信息

Best Pract Res Clin Obstet Gynaecol. 2023 Jul;89:102335. doi: 10.1016/j.bpobgyn.2023.102335. Epub 2023 Apr 8.

Abstract

Obesity in women is prevalent and growing at an alarming pace worldwide, resulting in significant healthcare and socioeconomic consequences. Obesity is a multisystemic disease that is associated with numerous comorbidities, particularly sleep-disordered breathing, hypertension, coronary artery disease, pulmonary hypertension, thromboembolism, and diabetes mellitus. Additionally, obesity poses several peri-operative challenges including difficulty with airway management and mechanical ventilation, challenges with intravenous access or regional blocks, the need for modified anaesthetic drug dosing, the requirement for correctly sized and rated equipment, and appropriate post-operative monitoring. Therefore, early multidisciplinary planning is crucial to identify and address important peri-operative and clinical issues. Parturients with obesity are especially at high risk due to the additional physiological changes and obstetric comorbidities associated with obesity. Antenatal anaesthetic consultation along with close communication and collaboration within the multidisciplinary team are important to improve maternal and neonatal safety.

摘要

全球范围内,女性肥胖症的发病率呈上升趋势且令人担忧,这给医疗保健和社会经济带来了重大影响。肥胖是一种多系统疾病,与许多合并症相关,特别是睡眠呼吸紊乱、高血压、冠状动脉疾病、肺动脉高压、血栓栓塞和糖尿病。此外,肥胖症在围手术期也带来了一些挑战,包括气道管理和机械通气困难、静脉通路或区域阻滞困难、需要调整麻醉药物剂量、需要合适的大小和评级设备以及适当的术后监测。因此,早期的多学科规划对于识别和解决重要的围手术期和临床问题至关重要。肥胖产妇由于与肥胖相关的额外生理变化和产科合并症,风险尤其高。产前麻醉咨询以及多学科团队内部的密切沟通和协作对于提高母婴安全性非常重要。

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