EFFECTIVE ANESTHESIA FOR ONCOGYNECOLOGICAL SURGERIES IN FEMALE PATIENTS WITH CONCURRENT OBESITY
https://doi.org/10.21292/2078-5658-2015-12-6-46-52
Abstract
The basic pathophysiologic characteristics, technical difficulties and handling methods thereof, including among others the difficult respiratory passages, the characteristics of ventilation and oxygenation, circulatory dynamics, dependence on the patient’s position on the operation table are described by the example of 60 gynecological cancer patients with concurrent obesity. It is shown that as of today the multimodal combined anesthesia based on the tricomponent epidural analgesia in combination with sevoflurane and apparently desflurane appears to be the best choice of anesthetic protection during traumatizing surgical treatment for the cancer patients with the associated obesity. The focus is made on advisability of hemodynamic monitoring of these patients.
About the Authors
M. A. Аnisimov
Blokhin Russian Oncology Research Center, Moscow
Russian Federation
Russian Federation
E. S. Gorobets
Blokhin Russian Oncology Research Center, Moscow
Russian Federation
Russian Federation
I. A. Yakushina
Blokhin Russian Oncology Research Center, Moscow
Russian Federation
Russian Federation
References
1. World Health Organisation, Ozhirenie i izbytochny ves. Informatsionnyj byulleten' no. 311. (Russ. Ed.: Obesity and overweight. Fact sheet no. 311). Updated January 2015. Available at: http://www.who.int/mediacentre/factsheets/fs311/ru/
2. Gorobets E.S., Kononenko L.P., Katamadze E.А. et al. First experience of epidural anesthesia with naropen in cancer patients of the high risk. Anesteziol. i Reanimatol., 2002, vol. 4, pp. 38-39.
3. Gorobets E.S. Variants of using epidural block with naropen in cancer surgery. Vestnik Intens. Terapii, 2006, vol. 3, pp. 63-68. (In Russ.)
4. Gorobets E.S. Concept of mutli-modal combined anesthesia - approach to safety provision of traumatic surgery. Vestnik Intens. Terapii, 2009, vol. 2, pp. 51-56. (In Russ.)
5. Zotov А.V., Gorobets E.S., Kononenko L.P. et al. Comparative evaluation of epidural anesthesia with ropivacainum and bupivacainum in major surgeries of oncogynecological surgeries. Vestnik Intens. Terapii, 2002, vol. 2, pp. 45-48. (In Russ.)
6. Tolmachev K.M. Sovremennye aspekty anesteziologicheskogo obespecheniya bol'nykh s izbytochnoy massoy tela. Diss. kand. med. nauk. [Modern aspects of anasthesiological support for obese patients. Cand. Diss.]. Moscow, 2004.
7. Epshteyn S.L., Storozhev V.Yu., Аzarova T.M. et al. Chest epidural anesthesia and analgesia with naropen in the perioperative period of the patients with concurrent obesity. Vestnik Intens. Terapii, 2005, vol. 4, pp. 52-58.
8. Epshteyn S.L., Yashkov Yu.I., Storozhev V.Yu. et al. Monitoring of anesthsia depth and perioperative epidural anesthesia/analgesia in the light of post-surgery rehabilitation of patients with concurrent obesity. Annaly Khirurgii, Materialy 4-go Rossiyskogo simpoziuma s mezhdunarodnym uchastiem. [Surgery annals. Materials of the 4th Russian Symposium with international participation]. Moscow, April 26-28, 2007, pp. 64-65. (In Russ.)
9. Alvarez A., Brodsky J.B., Hendrikus J.M. et al. Morbid obesity: peri-operative management: Second Edition. Cambridge University Press; 2010.
10. Bjorntorp P. «Portal» adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arteriosclerosis, 1990, vol. 10, pp. 493-496.
11. Bostanjian D., Anthone G., Hamoui N. Rhabdomyolysis of gluteal muscles leading to renal failure: a potentially fatal complication of surgery in the morbidly obese. Obesity Surgery, 2003, vol. 13, pp. 302-305.
12. Ettinger J., Marcilio C., Santos-Filho P. et al. Rhabdomyolysis: diagnosis and treatment in bariatric surgery. Obesity Surgery, 2007, vol. 17, pp. 525-532.
13. Khan M.A., Grinberg R., Johnson S. et al. Perioperative risk factors for 30 day mortality after bariatric surgery: is functional status important? Surgical Endoscopy, 2013, vol. 27, no. 5, pp. 1772-1777.
14. Niemi G., Breivik H. Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery. A randomised, double-blind, cross-over study with and without adrenaline. Acta Anaesthesiol Scand., 1998, vol. 42, no. 8, pp. 897-909.
15. Niemi G., Breivik H. Epinephrine markedly improves thoracic epidural analgesia produced by a small-dose infusion of ropivacaine, fentanyl, and epinephrine after major thoracic or abdominal surgery: a randomized, double-blinded crossover study with and without epinephrine. Anesthesia & Analgesia, 2002, vol. 94, no. 6, pp. 1598-1605.
16. Ortiz V.E., Wiener-Kronish J. eds. Perioperative anesthetic care of the obese patient. New York, Informa Healthcare USA; 2010.
17. Pöpping D.M., Elia N., Marret E. et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery. Archiv. Surgery, 2008, 143, no. 10, pp. 990-999.
18. Ramsay M.A., Savege T.M., Simpson B.R. et al. Controlled sedation with alphaxalone-alphadolone. Brit. Med. J., 1974, vol. 2(5920), pp. 656-659.
19. St-Pierre J., Lemieux I., Perron P. et al. Relation of the «hypertriglyceridemic waist» phenotype to earlier manifestations of coronary artery disease in patients with glucose intolerance and type 2 diabetes mellitus. Am. J. Cardiol., 2007, vol. 99, no. 3, pp. 369-373.
20. Tusman G., Bohm S.H., Vazquez de Anda G.F. et al. «Alveolar recruitment strategy» improves arterial oxygenation during general anaesthesia. Brit. J. Anaesthesia, 1999, vol. 82, pp. 8-13.
21. Whalen F.X., Gajic O., Thompson G.B. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesthesia & Analgesia, 2006, vol. 102, pp. 298-305.
Review
For citations:
Аnisimov M.A., Gorobets E.S., Yakushina I.A. EFFECTIVE ANESTHESIA FOR ONCOGYNECOLOGICAL SURGERIES IN FEMALE PATIENTS WITH CONCURRENT OBESITY. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2015;12(6):46-52. (In Russ.) https://doi.org/10.21292/2078-5658-2015-12-6-46-52
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