Schwilk B, Muche R, Bothner U, Brinkmann A, Bartels F, Georgieff M
Universitätsklinik für Anästhesiologie, Klinikum der Universität Ulm.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1995 Apr;30(2):99-107. doi: 10.1055/s-2007-996456.
Prevalence of cardiovascular risk factors in anaesthetic patients and perioperative pitfalls, events and complications (PECs) in different nutritional states were examined. The results should contribute to a current project of the German Society of Anaesthesiology and Intensive Care, established for quality assurance.
Preoperative data (age, sex, defined preexisting diseases, nutritional state, grade of urgency and ASA-class) were integrated in an automatically readable paper record, as well as the perioperative interventions and events, type of anaesthesia, and kind of operation. The records were routinely in use for every patient. After control and correction the data were stored in a modern data base. Data of patients under 16 years of age and incomplete sets of data were excluded from analysis.
From July 1, 1992 to December 31, 1993 23,056 anaesthesias were recorded, 5,852 (25.4%) of them with a total of 8,107 PECs. 17,255 patients had normal body weight and 23% of them PECs. 4,484 obese (but not extremely) patients had a PEC rate of 31.2%, 330 extremely obese patients had a PEC rate of 38.2%, 966 patients with underweight (but not extremely) had a PEC rate of 36.1% and 21 with extreme underweight had a PEC rate of 38.1%. Obese patients had a higher prevalence of preexisting cardiovascular disturbances (angina pectoris, myocardial infarction and hypertension) and tended to a higher incidence of perioperative hypertensive, bronchospastic and hypoxic events as well as more difficulties in application of regional anaesthesia. Young adult patients (16-39 years) had a PEC rate of 14% in case of normal nutritional state but of 20% in case of obesity. The incidence of respiratory PECs and of PECs of higher severity was almost double in obese young patients compared to normal weight patients of the same age. When preoperative cardiovascular disease was known there was little difference between the different states of nutrition in respect of perioperative PECs.
Nutritional disorder is an important epidemiological factor in anaesthesia. Particularly in younger patients without defined preoperative cardiovascular disturbance but with obesity the anaesthesist may be surprised by a remarkable incidence of relevant problems during and immediately after anaesthesia. We should consider the possible phenomenon that we are underestimating the anaesthetic challenge in young obese patients in a "healthy" cardiovascular state.
