Skip to main content Skip to main navigation menu Skip to site footer

Manajemen anestesi pada operasi bariatric pasien obesitas: Laporan kasus

Abstract

Abstrak

Sekitar 13% populasi dunia dewasa mengalami tahun 2016 mengalami obesitas. Operasi bariatric dipertimbangkan sebagi terapi jangka panjang yang efektif pada pasien dengan BMI ≥ 40 atau ≥ 35 dengan komorbid sehingga pasien dapat secara signifikan dan konsisten menurunkan berat badan. Penurunan berat badan dengan operasi dapat dikatagorikan malabsorptif, restriktif, atau kombinasi keduanya. Jejuno-ileal bypass dan bilipankreatik bypass adalah metode malabsorpsi yang jarang digunakan saat ini. Prosedur laparoskopi saat ini lebih unggul. Dapat mendapatkan keuntungan yang lebih dibandingkan dengan open bariatric surgery dengan pemulihan yang lebih cepat menurunkan resiko dari komplikasi pulmonal post operasi dan menurunkan nyeri pasca operasi. Laki-laki 47 tahun dengan BB 205 kg; TB 174 cm; BMI 67.71 kg/m2, obesitas dilakukan laparoscopy bariatric. Induksi pasien dilakukan anestesi umum dengan induksi menggunakan propofol TCI, fentanyl 200mcg, dengan pelumpuh otot vecuronium 10mg, video laringoskopi, dengan ETT cuff no. 8. Saat operasi ETCO2 mengalami kenaikan hingga 70mmHg karena pemberian CO2 memperberat asidosis respiratorik pada pasien. Komplikasi durante operasi sering terjadi dan harus segera ditangani sebelum memperburuk keadaan pasien. Posisi pasien secara reverse trendlenberg dan pemberian PEEP durante operasi dapat mengurangi peningkatan ETCO2 pada pasien.


Abstract

Obesity went up to 13% of adult world population in 2016. Bariatric operations used as considerations of long term treatment which is effective in patient with BMI ≥ 40 or ≥ 35 with comorbid so patient consistently and significant decreasing body weight. Decreasing body weight using operations categorized as mal-absorptive, restrictive, or both of it. Jejuno-ileal bypass and bilio-pancreatic bypass is used as malabsorption methods. Laparoscopy procedure is superior. Rather than open bariatric procedure laparoscopy had any advantages such as speedy recovery, which decrease risk and complications post operations and also decreasing post operative pain. Man 47y.o. with BW 205kg, BH 174 cm; BMI 67.71 kg/m2, obesity performed laparoscopy bariatric. Inductions using propofol TCI, fentanyl 200mcg with muscle relaxant using vecuronium 10mg, video laryngoscopy, with ETT cuff no.8. During the operation ETCO2 increased to 70mmHg due to CO2 inflation and respiratory acidosis get worse. Complications during the operations usually happens and need to be handled before patient conditions getting worse. Patient positions using reverse Trendelenburg and giving PEEP during the operations decreasing ETCO2 in patient.

References

  1. WHO.int[internet]. Obesity and Overweight, [updated on 16 Feb 2018, cited 2 Jan 2019] available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  2. Lobo, E. 2009, Morbid Obesity, Perioperative Anesthetic Considerations for the Morbidly Obese Patient, University of California San Francisco, avaialable at : www.ucsfcme.com/2010slidesMSU/100108Lobo.pdf
  3. David C.W., James D.D., Katherine M.M., Irene M.H., Arya M.S., 2007, 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. Canadian Medical Association Journal. vol 176. no 8. p 1-117.
  4. Brodsky, J.B. 2008, Perioperative Management of The obese Patient, Conferencias Magistrales, vol 31, supl 1; pp s85-s89
  5. Kuchta, K., 2004, Obesity, in : Cole, D.J., Schlunt, M., editor. Adult Perioperative Anesthesia. 1st ed. Philadelphia. Elsevier Mosby; p 430-436
  6. Jaffe, Richard A., 2014, Anesthesiologist’s Manual of Surgical Procedure, Wilter Kluwer Health, p971-975.
  7. Kristensen, M.S., 2010, Airway Management and Morbid Obesity, European Journal Anaesthesiology, vol 27; p923-927
  8. Chambers, W.A. Beckwith, P., Bellamy, M., Denny, N., Dresner, M., Finer, N., Hartle, A., Houghton, K., Milton, S., Sugden, J., 2007, Peri-operative Management of The Morbidly Obese Patient, The Association of Anaesthetists of Great Britain and Ireland, available at : www.aagbi.org/publications/guidelines/peri-operative-management-morbidly-obese-patient
  9. Brodsky, J.B. 2008, Perioperative Management of The obese Patient, Conferencias Magistrales, vol 31, supl 1; pp s85-s89
  10. Andrea, C., Marta, P., 2004, Anesthesia in the obese patient: Pharmacokinetic considerations. Journal of Clinical Anesthesia, vol 17, p 134-145.
  11. Leone, B.J., 2007, Obstructive Sleep Apnea and Anesthesia, Conferencias Magisteriales, vol 30, supl. 1, pp s37-s40
  12. Thomas, K.H., 2004, Anesthetic Considerations in the Morbidly Obese Patient, Department of Anesthesiology University of Colorado, available at : www.cucrash.com/Handouts04/MorbObeseHenthorn.pdf
  13. Yigal, P., Tommaso, P., 2009, Pathophysiological and Perioperative Features of Morbidly Obese Parturients, Expert Review of Obstetry Gynecology, vol 4 (3), p 313-319.
  14. Stoelting, R.K., Dierdorf, S.F., 2002, Nutritional Disease and Inborn Errors of Metabolism. In : Anesthesia and Co-existing Disease. 4th ed. Philadelphia: Churchill Livingstone. p.441-470.
  15. Morgan, G.E., Mikhail, M.S., Murray, M.J. 2006. Anesthesia for Patien with endocrine Disease. In : Clinical Anesthesiology, 4th ed. USA.Lange Medical/McGraw-Hill; p 813-815
  16. Collins, V.J., Badola, R.P., 1996, Selected Acute and chronic Disease, in : Collins, V.J, editor. Physiologic and Pharmacologic Bases of Anesthesia. USA. Williams & Wilkins; p 805-817
  17. Mhyre, J.M., 2005, Anesthetic Management for the Morbidly Obese Pregnant Woman, University of Michigan Health System, available at : www.ncbi.nlm.nih.gov/pubmed/17215699
  18. Lotia, S., Bellamy, M.C., 2008, Anaesthesia and Morbid Obesity, Continuing Education in Anaesthesia, Critical Care and Pain, vol 8 number 5; p 151-156 .
  19. Adams, J.P., Murphy, P.G., 2000, Obesity in anesthesia and intensive care. British Journal of Anaesthesia, vol 85 (1). p 91-108.
  20. Ingrande, J., Brodsky, J.B., Lemmens, H.J., 2009, Regional anesthesia and Obesity, Current Opinion in Anaesthesiology, 22; p 683-686

How to Cite

Wibawa, I. B. G. D., & Aryasa, T. (2020). Manajemen anestesi pada operasi bariatric pasien obesitas: Laporan kasus. Medicina, 51(3). https://doi.org/10.15562/medicina.v51i3.903

HTML
112

Total
165

Share

Search Panel

Ida Bagus Gita Dharma Wibawa
Google Scholar
Pubmed
Medicina Journal


Tjahya Aryasa
Google Scholar
Pubmed
Medicina Journal