md-medicaldata

Authors

 

Natalija Trninić<sup>1

1</sup>Klinički centar Crne Gore

 

UDK: 613.25:616-089.5

The paper was received / Rad primljen: 23.04.2019. /

Accepted / Rad prihvaćen: 02.12.2019.

 

Correspondence to:

Dr Natalija Trninić
Klinički centar Crne Gore
Ljubljanska 1, 81000 Podgorica
Telefon:+381 69 049 226
e-mail: natalijat@t-com.me

 

 

Sažetak

 

U svijetu, a i kod nas, sve je više gojaznih pacijenata, a takođe i morbidno gojaznih. Uzroci gojaznosti su brojni, prije svega genetski, zatim oni koji potiču iz životne sredine, endorkine bolesti i dr. Regulacija apetita je kompleksan proces koji je pod kontrolom brojnih humoralnih i neuroloških komponenti kontrolisanih od strane hipotalamusa. Takođe, unos hrane zavisi od više hormona kao što su leptin, adiponektin, insulin, ghrelin i dr. Gojaznost predstavlja multisistemski poremećaj i sa sobom nosi brojne rizike, tako da su gojazni ljudi često sa brojnim komorbiditetima, prije svega respiratornim, kardiovaskularnim i dr. Smatra se da BMI >35/m2 sa komorbiditetom, ili BMI >40/m2 bez komorbiditeta predstavlja morbidnu gojaznost, odnosno BMI >50/m2 super morbidnu gojaznost, te je kod ovih pacijenata znatno povećana stopa i morbiditeta i mortaliteta. Gojazni ljudi često pate od sleep apnee, hipoventilacionog sindroma gojaznih i drugih respiratornih poremećaja. Gojaznost je često udružena sa dislipidemijom, hipertenzijom, masnom jetrom, dijabetesom i dr. U toku anestezije, kod gojaznih ljudi dolazi do brojnih poremećaja, prije svega od strane respiratornog sistema. Kod ovih pacijenata dolazi do brže desaturacije u uslovima apnee. Komplijansa grudnog koša je smanjena usljed težine masnog tkiva oko grudne duplje, te dolazi do kolapsa malih disajnih puteva a usljed povećanog protoka krvi kroz pluća dolazi do smanjenja funkcionalnog rezidualnog kapaciteta. Zato vođenje anestezije kod gojaznih i morbidno gojaznih pacijenata  kao i adekvatan postoperativni tok  i oporavak nakon operacije predstavlja poseban izazov za svakog anesteziologa. Da bi vođenje anestezije i postoperativni tok protekli u redu važno je da anesteziolog dobro poznaje patofiziološka zbivanja koja se dešavaju sa morbidno gojaznim pacijentom u toku anestezije, kao i da preduzme sve potrebne mjere koje će spriječiti nastanak komplikacija  prije, u toku i nakon operacije.

 

 

Ključne reči:

gojaznost, anestezija, disajni put, respiratorni sistem, kardiovaskularni sistem, komplikacije

 

 

Abstract

 

All over the world there is an increasing number of obese patients, and also morbidly obese. The causes of obesity are numerous, genetic, environmental, endocrine disease and other. Appetite regulation is a complex process under the control of numerous humoral and neurological components controlled by hypothalamus. Also, food intake depends on hormones such as leptine, adiponectine, insulin, ghrelin. Obesity represents multi-system disorder and is accompanied by numerous risks, thus obese persons frequently have comorbidities, respiratory, cardiovascular and other. It is considered that BMI >35/m2 with comorbidity, or BMI >40/m2 without comorbidity represents morbid obesity, while BMI >50/m2 represents super morbid obesity, and in these patients the morbidity and mortality rate is increased. Obese persons frequently suffer from sleep apnea, hypoventilation syndrome of obese and other respiratory disorders. Obesity is frequently joined with dyslipidaemia, hypertension, fatty liver, diabetes and other. In these patients there is faster desaturation in conditions of apnea. Chest wall compliance is reduced due to fatty tissue around the chest cavity, which causes collapse of small airways, and due to increased pulmonary blood circulation there is reduced functional residual capacity. This is why administration of anaesthesia in obese and morbidly obese patients and adequate post-operative course represent a special challenge for every anaesthesiologist. Anaesthesiologists must have good knowledge of the pathophysiological events happening in morbidly obese patients during anaesthesia so that anaesthesia and postoperative course go smoothly, and they must know to undertake all measures needed to prevent the complications before, during and after operation.

 

 

Key words:

obesity, anaesthesia, airway, respiratory system, cardiovascular system, complications

 

 

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PDF Trninić N. et al • MD-Medical Data 2019;11(3-4): 153-157