Obesity has become a growing health problem globally, and obese patients face unique challenges in the management of pain anesthesia when they undergo surgical treatment. Understanding these challenges and developing effective responses are essential to ensuring the safety of obese patients and their post-operative rehabilitation.
I. The challenge of anaesthesia for obese patients
(1) Respiratory limitations
1. Reduction in lung capacity
Obesity results in a reduction in total lung, lung activity, functional disability, etc., as a result of the accumulation of abdominal fat, the lifting of abdomen and a decrease in the responsiveness of the chest. This increases the vulnerability of patients to low oxygen and high carbonate haematosis during anaesthesia induction and maintenance, making respiratory management more difficult. For example, respiratory disorders are more pronounced for obese patients when they are in bed, with the risk of a gas/blood flow disorder.
2. Airway management difficulties
Obesity patients accumulate fat on their necks, throats, etc., and the aromatic anatomical structure changes, making them prone to post-tongue crashes and narrow throats. At the same time, there has been a significant increase in the difficulty of obese patients with gas masks and gas tube intubation, which can lead to intubation failures and extended oxygen-deficient periods, which place greater demands on the aerobic management skills of anesthesiologists.
(2) Increased burden of cardiovascular system
1. Increased blood capacity and heart output
Fatty tissues in obese patients have increased, blood capacity and heart output have increased accordingly, and the heart has been in high load for a long time. In the course of anaesthesia, changes in blood flow mechanics may be more likely to cause cardiovascular complications such as cardiac disorders and ischaemic blood. For example, in cases of anaesthesia, the risk of low or high blood pressure is higher for obese patients because of the effect of the drug on the cardiovascular system.
2. Risk of sclerosis of high blood pressure and anorexia
Obesity is often accompanied by cardiovascular diseases such as high blood pressure and the hardening of arteries, which affect patient resistance to narcotic drugs and the stability of the cardiovascular system. During anaesthesia of pain, blood pressure may be more volatile, increasing the risk of surgery.
(3) Changes in drug metabolism
1. Changes in drug distribution volume
Changes in the body composition of obese patients and an increase in fat tissues have increased the volume of the distribution of lipid soluble narcotic drugs. This may lead to an increase in the accumulation and duration of the effects of the drug in the body, and increases the likelihood of adverse reactions, such as delayed awakening, respiratory depression, etc.
Changes in drug clearance rates
The liver and kidney function of obese patients may be affected and the metabolic and removal process of drugs may change. Some liver metabolism or kidney excretion drugs may have a lower clearance rate in obese patients, and there is a need to adjust the dose and time interval to avoid overdose.
(4) Post-operative pain management challenges
1. Incision pain and respiratory effects
Obesity patients may experience more severe post-operative oral pain, which not only increases the pain of the patient, but may also lead to shallow breathing, further increases respiratory disorders and increases the risk of lung complications, such as pneumonia and pneumonia.
Risk of haemobolism
Obesity is in itself a high-risk group for haematosis, and reduced post-operative pain-related activity further increases the likelihood of deep-infective haembolism, which can lead to pulmonary embolism in serious cases.
Response
(1) Pre-operative assessment and preparation
1. Overall assessment
Detailed pre-operative assessments of obese patients include respiratory function tests (e.g., pulmonary activity, arterial and gas analysis, etc.), cardiovascular system examinations (EKG, ultrasound, etc.), liver and kidney function assessments, and knowledge of obese-related complications. Based on the results of the evaluation, a personalized anaesthesia programme was developed.
2. Optimizing patient status
For patients with respiratory disorders, pre-operative respiration training is provided to guide patients in deep breathing and effective coughing. For people who combine cardiovascular diseases, there is active control of blood pressure, improvement of blood supply, etc. At the same time, the patient is required to reduce the risk of surgery by appropriately reducing the weight before the operation.
(2) Anaesthesia method selection and management
1. Regional detoxification
In appropriate operations, priority is given to regional detoxifications, such as intra-vertebral anesthesia or neurodetoxification. Regional detoxification can reduce the effect of the overall anesthesia on the respiratory and cardiovascular system while providing some relief for post-operative pain. However, in the course of implementation, attention should be paid to changes in the anatomy structure of obese patients and to improving the success rate of piercing.
2. General anesthesia management
If anaesthesia is selected, anaesthesia is induced by the choice of drugs that have less impact on cardiovascular and respiratory functions, and appropriate induction techniques, such as slow induction, pre-oxidation, etc., are used to reduce oxygen deficiency time. During the maintenance phase of anaesthesia, the doses and types of drugs are reasonably adjusted to the duration of the operation and the patient ‘ s condition, and respiratory and blood flow mechanics parameters are closely monitored. For airway management, tools such as multiple models of catheters, larynx, etc., can be prepared, and advanced equipment such as video larynx can be used to assist the intubation.
The pain anaesthesia management of obese patients is challenging, and a combination of responses can improve the safety and effectiveness of anesthesia of obese patients and promote their post-operative rehabilitation.
