Anaesthesiological Maintenance of Patients with Obesity

Pathophysiological features of morbid obesity and the associated functional-anatomical changes in an organism demand the special approach to anaesthesiological maintenance. Methods of anaesthesiological protection and maintenance of effective gas exchange in morbide obesity patients have been proved. Anaesthesias for 110 patients have been analysed. Multicomponent anesthesia with traditional and combined artificial lung ventilation (ALV) (IPPV+HFJV) (intermittent positive pressure ventilation and high frequency jet ventilation) was used. Since 2000, morbid obesity patients receive intubation only with fibrobronchoscope with self breathing under local anesthesia. In IPPV for morbid obesity patients high peak pressure in airways, low V/Q, and low PaO₂ occurs. Technology of combined ALV (IPPV+HFJV) has led to pressure decrease in airways and to effective arterial oxygenation improvement, intrapulmonary shunt has decreased. Retrospective analysis of anesthesia components revealed that the applied anaesthetic doses correspond to calculations on ideal body weight, and not true weight. Thus, anaesthesiological maintenance of operated patients with morbid obesity requires trachea intubation with fibroscope under local anaesthesia with self-breathing; high efficiency of ALV methods, allowing lower pressure in airways and high oxygenation (IPPV+HFJV), which provides effective gas exchange; doses correction of intravenous anaesthetics for due body weight is required.