TYK276
A 16-year-old female who is 128 kg with a BMI 48 presents for gastric bypass surgery. Preoperative evaluation should include:
a) Thorough airway examination
b) EKG
c) Blood glucose
d) Pregnancy testing
e) All of the above
Answer
Answer e. All of the above. Morbid obesity presents a myriad of challenges to the anesthesiologist. Bariatric surgical procedures are considered for some selected adolescents due to the fact that they can reduce morbidity from obesity. However, the surgery is not benign, and the patients who present may already have accumulated a number of medical issues that complicate anesthetic management. Pulmonary function may be decreased with a reduction in FRC and closing capacity, and chronic hypoxemia due to airway obstruction may present with pulmonary hypertension. The weight loss achieved can reverse cardiac dysfunction, including hypertension and pulmonary hypertension. The morbidly obese patient is much more likely to suffer from gastroesophageal reflux disease, associated with increased gastric volumes and a lower pH. Therefore, induction should be balanced against the potential difficult airway and the possibility of aspiration. Careful preoperative airway assessment should take place and positioning is of utmost importance. A thorough review of systems should take place in order to discover the possibility of heart disease, diabetes or insulin resistance. For intraoperative care, central venous access should be considered in light of the potential difficulty of peripheral IV access, and also arterial cannulation should be considered, as non-invasive cuff monitoring may not be accurate, intraoperative and postoperative frequent laboratory evaluation (including arterial blood gas analysis) may also warrant arterial cannulation. 3
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.