Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942006000300001
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia para cirurgia bariátrica: avaliação retrospectiva e revisão da literatura

Anesthesia for bariatric surgery: retrospective evaluation and literature review

Airton Bagatini; Rubens Devildos Trindade; Cláudio Roberto Gomes; Renésio Marcks

http://dx.doi.org/10.1590/S0034-70942006000300001 Braz J Anesthesiol, vol.56, n3, p.205-222, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: O tratamento cirúrgico para a obesidade mórbida é forma eficaz de manutenção do controle ponderal por longo prazo. O objetivo deste trabalho foi realizar um levantamento das complicações, das comorbidades e dos principais aspectos do manuseio anestésico de pacientes submetidos à cirurgia da obesidade e comparar os resultados com os dados encontrados na literatura. MÉTODO: O trabalho foi realizado por meio de revisão bibliográfica e análise retrospectiva do prontuário dos pacientes submetidos à cirurgia bariátrica entre setembro de 2001 e dezembro de 2004. Todos foram submetidos ao mesmo procedimento, técnica de Capella, por laparotomia, realizada por uma única equipe cirúrgica e no mesmo hospital. RESULTADOS: Houve predomínio de pacientes do sexo feminino, a média de idade foi de 39,6 anos e o índice de massa corporal (IMC) médio foi de 44,65 kg/m². A hipertensão arterial sistêmica (HAS) foi a doença mais prevalente e as complicações encontradas foram trombose de veia subclávia, infecção pulmonar, bloqueio neuromuscular residual, sangramento gastrintestinal no pós-operatório, obstrução intestinal e deiscência anastomótica. O índice de mortalidade foi de 0,7%. CONCLUSÕES: As doenças como HAS e osteoartrose são muito prevalentes em pacientes obesos. Dentre as complicações do pós-operatório destacam-se as do sistema respiratório. Com isso percebe-se a importância do uso de técnica anestésica e de analgesia pós-operatória, que permita ao paciente a deambulação precoce, bem como a capacidade de respirar e tossir de forma adequada. Observou-se que muitos aspectos da anestesia do paciente obeso já estão definidos como benéficos ou prejudiciais; entretanto, vários assuntos ainda encontram-se indefinidos e cabe estudar e discutir para que se consiga melhorar cada vez mais o manuseio anestésico desses pacientes.

Palavras-chave

ANESTESIA, Geral, CIRURGIA, Abdominal, COMPLICAÇÕES, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Surgical treatment for morbid obesity is an effective way to maintain weight control in the long run. This study aimed at compiling complications, co-morbidities and major anesthetic aspects of patients submitted to bariatric procedures and at comparing results with data in the literature. METHODS: This study has reviewed the literature and retrospectively analyzed the records of patients submitted to bariatric surgery between September 2001 and December 2004. All patients were submitted to the laparotomy Capella technique performed by the same surgical team in the same hospital. RESULTS: Females were predominant, mean age was 39.6 years and mean body mass index (BMI) was 44.65 kg/m². Systemic arterial hypertension (SAH) was the most prevalente associate disease and complications observed were subclavian vein thrombosis, pulmonary infection, residual neuromuscular block, postoperative gastrointestinal bleeding, intestinal obstruction and anastomotic dehiscence. Mortality rate was 0.7%. CONCLUSIONS: Diseases such as SAH and osteoarthritis are highly prevalent in obese patients. There were major postoperative respiratory system complications. This stresses the importance of the anesthetic technique and of postoperative analgesia allowing for early ambulation and the ability to normally breathe and cough. It has been observed that several aspects of anesthesia for obese patients are already defined as beneficial or noxious; however, several subjects are still undefined and should be discussed and studied to constantly improve the anesthetic management of such patients.

Keywords

ANESTHESIA, General, COMPLICATIONS, DISEASES, SURGERY, Abdominal

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