Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000200009
Brazilian Journal of Anesthesiology
Scientific Article

Problemas clínicos pré-anestésicos de pacientes morbidamente obesos submetidos a cirurgias bariátricas: comparação com pacientes não obesos

Preanesthetic clinical problems of morbidly obese patients submitted to bariatric surgery: comparison with non-obese patiens

Getúlio Rodrigues de Oliveira Filho; Tânia Helena Carnieleto Nicolodi; Jorge Hamilton Soares Garcia; Marcos Antônio Nicolodi; Ranulfo Goldschmidt; Adilson José Dal Mago

http://dx.doi.org/10.1590/S0034-70942002000200009 Braz J Anesthesiol, vol.52, n2, p.217-222, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A obesidade mórbida associa-se a problemas clínicos, responsáveis por diminuição da expectativa de vida. Pacientes obesos mórbidos são candidatos a cirurgias bariátricas, impondo novos desafios ao anestesiologista. Este estudo comparou a prevalência de problemas clínicos entre pacientes morbidamente obesos submetidos a cirurgias bariátricas e não obesos submetidos a outros procedimentos eletivos. MÉTODO: Foram estudados, retrospectivamente, os registros eletrônicos de 2986 pacientes divididos em grupo 1, obesos mórbidos submetidos a cirurgias bariátricas e grupo 2, com índice de massa corporal menor que 30, submetidos a outros procedimentos eletivos, relacionados ao grupo 1 pela idade, sexo e estado físico (ASA). Os problemas pré-anestésicos do grupo 1 foram pesquisados no grupo 2 e as prevalências comparadas. As razões de chance (RC) e respectivos limites de 95% de confiança (LC 95%) foram calculados. RESULTADOS: Os problemas identificados nos grupos 1 e 2 e suas respectivas prevalências foram: refluxo gastroesofágico (16,67% e 0,48%), hipertensão arterial sistêmica (50% e 3,06%), diabete melito tipo II (6,25% e 0,31%), hipotireoidismo (6,25% e 0,31%), asma brônquica (10,42% e 1,43%) e pneumopatia restritiva (10,42% e 0,03%). As prevalências foram significativamente mais altas no grupo 1. Foram ainda identificados, no grupo 1, os seguintes problemas que não foram encontrados no grupo 2: epilepsia (2,08%), esteatose hepática (12,5%), colecistopatia calculosa (6,25%), dislipidemia (20,83%) e hipopituitarismo (2,08%). CONCLUSÕES: A prevalência de problemas clínicos é significativamente mais alta em pacientes portadores de obesidade mórbida do que em não obesos de mesma idade, sexo e estado físico.

Palavras-chave

AVALIAÇÃO PRÉ-ANESTÉSICA, CIRURGIA, Abdominal

Abstract

BACKGROUND AND OBJECTIVES: Morbid obesity is associated to clinical problems responsible for decreased life expectancy. Morbidly obese patients are candidates to gastric bypass and pose new challenges to the anesthesiologist. This study compared the prevalence of clinical problems among morbidly obese patients submitted to bariatric surgery to non-obese patients submitted to other elective surgical procedures. METHODS: Electronic records of 2986 patients were retrospectively studied. Patients were divided in two groups; 1: patients with morbid obesity submitted to bariatric surgeries; and group 2: non obese patients (body mass index less than 30 kg.m-2), submitted to other elective surgical procedures. Groups were matched according to age, gender and ASA physical status. Preanesthetic problems common to group 1 were investigated in group 2, and prevalence was compared. Odds ratios and 95% confidence limits were calculated. RESULTS: Clinical problems identified in groups 1 and 2 and their respective prevalence were: gastroesophageal reflux (16.67% and 0.48%), systemic hypertension (50% and 3.06%), type II diabetes mellitus (6.25% and 0.31%), hypothyroidism (6.25% and 0.31%), bronchial asthma (10.42% and 1.43%) and restrictive lung disease (10.42% and 0.03%). Incidences were significantly higher in group 1. Additionally, the following problems were found in group 1, but not in group 2: epilepsy (2.08%), nonalcoholic fatty liver (12.5%), gall bladder stones (6.25%), dyslipemia (20.83%) and hypopytuitarism (2.08%). CONCLUSIONS: The prevalence of clinical problems was significantly higher in morbidly obese patients as compared to their non-obese counterparts.

Keywords

PREANESTHETIC EVALUATION, SURGERY: Abdominal

References

Baxter J. Obesity surgery: another unmet need: it is effective but prejudice is preventing its use. BMJ. 2000;321:523-524.

Largergren J, Bergstrom R, Nyren O. No relation between body mass and gastro-esophageal reflux symptom in a Swedish population based study. Gut. 2000;47:26-29.

Fisher BL, Pennathur A, Mutnick JL. Obesity correlates with gastroesophageal reflux. Dig Dis Sci. 1999;44:2290-2294.

Wilson LJ, Ma W, Hirschowitz BI. Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol. 1999;94:2840-2844.

Jaffin BW, Knoepflmacher P, Greenstein R. High prevalence of asymptomatic esophageal motility disorders among morbidly obese patients. Obes Surg. 1999;9:390-395.

Locke III GR, Talley NJ, Fett SL. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642-649.

Chung F, Mezei G, Tong D. Pre-existing medical conditions as predictors of adverse events in day-case surgery. Br J Anaesth. 1999;83:262-270.

Koch R, Sharma AM. Obesity and cardiovascular hemodynamic function. Curr Hypertens Rep. 1999;1:127-130.

Bourdages H, Goldenberg F, Nguyen P. Improvement in obesity-associated medical conditions following vertical banded gastroplasty and gastrointestinal bypass. Obes Surg. 1994;4:227-231.

Abu-Abeid S, Keidar A, Szold A. Resolution of chronic medical conditions after laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity in the elderly. Surg Endosc. 2001;15:132-134.

Castro-Cabezas M, Halkes CJ, Erkelens DW. Obesity and free fatty acids: double trouble. Nutr Metab Cardiovasc Dis. 2001;11:134-142.

Sjostrom CD, Peltonen M, Wedel H. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension. 2000;36:20-25.

Proces S, Delgrange E, Vander-Borght TV. Minor alterations in thyroid-function associated with diabetes mellitus and obesity in outpatients without known thyroid illness. Acta Clin Belg. 2001;56:86-90.

Tagliaferri M, Berselli ME, Calo G. Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile. Obes Res. 2001;9:196-201.

Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121:91-100.

Chitturi S, Farrel GC. Etiopathogenesis of nonalcoholic steatohepatitis. Sem Liver Dis. 2001;21:27-41.

Biring MS, Lewis MI, Liu JT. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318:293-297.

Zerah-Lancner F, Lofaso F, Coste A. Pulmonary function in obese snorers with and without sleep apnea syndrome. Am J Respir Crit Care Med. 1997;156:522-527.

Pelosi P, Croci M, Ravagnan I. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. J Appl Physiol. 1997;82:811-818.

Hakala K, Mustajoki P, Aittomaki J. Effect of weight loss and body position on pulmonary function and gas exchange abnormalities in morbid obesity. Int J Obes Relat Metab Disord. 1995;19:343-346.

Dixon JB, Chapman L, O’Brien P. Marked improvement in asthma after Lap-Band surgery for morbid obesity. Obes Surg. 1999;9:385-389.

Dhabuwala A, Cannan RJ, Stubbs RS. Improvement in co-morbidities following weight loss from gastric bypass surgery. Obes Surg. 2000;10:428-435.

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