Posebnosti anestezije pri morbidno debelem bolniku z rakom Peculiarities of anesthesia in the morbidly obese cancer patient

prikaz primera

Povzetek

Debelost je kronična bolezen, za katero je značilno čezmerno kopičenje maščevja v telesu. Debeli bolniki imajo pogosto številne pridružene bolezni ter anatomske in presnovne spremembe, ki so povezane z večjim tveganjem za zaplete v perioperativnem obdobju. Debelost tako pomembno vpliva na izbiro anestezijske tehnike in zahteva multidisciplinarni pristop. V prispevku predstavljamo primer 60-letne bolnice z rakom na debelem črevesu in indeksom telesne mase (ITM) 48,1 kg/m2. Perioperativno smo jo obravnavali v skladu s protokolom za hitro okrevanje po kirurškem posegu (angl. Enhanced Recovery After Surgery, ERAS). Pred kirurškim posegom smo ocenili morebitna tveganja in jih upoštevali pri vodenju anestezije med kirurškim posegom. Po posegu smo bolnico obravnavali v enoti intenzivne terapije (EIT). V prispevku se osredotočamo na anesteziološke vidike perioperativnega vodenja. Čeprav je debelost nedvomno pomemben dejavnik tveganja kirurškega zdravljenja, pa v novejših raziskavah poročajo tudi o ugodnih vplivih debelosti z manjšo perioperativno obolevnostjo in smrtnostjo. Gre za t. i. paradoks debelosti, saj čezmerna telesna masa velja za zaščitni dejavnik, ki varuje pred zapleti kirurškega zdravljenja, kar smo potrdili tudi v našem primeru. Hkrati smo opredelili kritične točke pri anesteziji morbidno debelega bolnika in tista področja, na katerih lahko anesteziologi – ob upoštevanju protokola ERAS – pomembno prispevamo k bolnikovemu čim hitrejšemu okrevanju.

Abstract (Eng)

Obesity is a chronic disease characterized by an excessive accumulation of body fat. Obese patients often have a number of comorbidities as well as anatomical and metabolic changes that increase the risk of complications in the perioperative period of treatment and significantly influence the choice of anesthetic technique as well as requiring a multidisciplinary approach. In this article, we present the case of a 60-year-old female patient with colon cancer and a body mass index (BMI) of 48.1 kg/m2. She was treated perioperatively in accordance with the Enhanced Recovery After Surgery (ERAS) protocol. Before surgery, we assessed possible risks and took them into account when managing anesthesia during surgery. After surgery, the patient was treated in the intensive care unit (ICU). In this paper, we focus on the anesthesiology aspects of perioperative management. Although obesity is undoubtedly an important risk factor for surgical treatment, recent studies report favorable effects of obesity with lower perioperative morbidity and mortality. This is the so-called obesity paradox, as excessive body mass is considered a protective factor that protects against complications of surgical treatment, which we also confirmed in our case. At the same time, we defined the critical points in the anesthesia of a morbidly obese patient and identified those areas in which anesthesiologists — taking into account the ERAS protocol — can make a significant contribution to the patient recovering as quickly as possible.