The Laryngeal Mask Airway ProSeal ™ as a temporary ventilatory device in grossly and morbidly obese patients before laryngoscope-guided tracheal intubation. Keller C, Brimacombe J, Kleinsasser A, et al. ProSeal™ LMA increases safe apnea period in morbidly obese patients undergoing surgery under general anesthesia. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. How to preoxygenate in operative room: healthy subjects and situations “at risk”. 2003 13:4–9.ĭe Jong A, Futier E, Millott A, et al. A preliminary study of the optimal anesthesia positioning for the morbidly obese patient. Preoxygenation is more effective in the 25 o head-up position than in the supine position in severely obese patients. Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea. The effects of the reverse Trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Obesity supine death syndrome: reports of two morbidly obese patients. Effects of posture on respiratory mechanics in obesity. Cardiovascular and respiratory changes in response to change in posture in the very obese. Expiratory flow limitation and orthopnea in massively obese subjects. 1997 82:811–8.įerretti A, Giampiccolo P, Cavalli A, et al. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. Pulmonary physiologic changes of morbid obesity. Spirometry in normal subjects in sitting, prone, and supine positions. Positioning the morbidly obese patient for anesthesia. Head-elevated laryngoscopy position (HELP)īrodsky JB. For any surgical position, all dependent pressure points must be adequately padded and the patient’s head, neck, and extremities supported to prevent perioperative neurologic and muscle injuries. Standard operating room tables are not safe for extremely obese patients, so special attention is important when moving the table or when changing patient position to avoid accidents. Ramping the patient’s upper body and head improves the view during direct laryngoscopy resulting in greater success with tracheal intubation. This position also facilitates bag-mask assisted ventilation. Tilting the operating room table to the reverse Trendelenburg position during induction of anesthesia increases the patient’s oxygen reserves, which results in a longer safe apnea period. A spontaneously breathing obese patient should never lie supine, whether before, during, or immediately after surgery. When placed in a non-physiologic position, the obese patient can experience significant cardiopulmonary dysfunction. An important part of every bariatric patient’s perioperative management is proper positioning.
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