Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000100012
Brazilian Journal of Anesthesiology
Review Article

Vias aéreas e conteúdo gástrico no paciente obeso

The airways and gastric contents in obese patients

Leonardo de Andrade Reis; Guilherme Frederico Ferreira dos Reis; Milton Roberto Marchi de Oliveira

http://dx.doi.org/10.1590/S0034-70942010000100012 Braz J Anesthesiol, vol.60, n1, p.98-103, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: O presente artigo teve como objetivo rever as referências bibliográficas e questionar o conceito de que o obeso deve ser considerado de estômago cheio, questionando, consequentemente, a forma como a via aérea deve ser abordada na indução da anestesia geral, considerada de difícil acesso devido à obesidade. CONTEÚDO: Classicamente, o paciente obeso é considerado de estômago cheio, levando a condutas protetoras das vias aéreas durante a indução da anestesia geral. Frequentemente, são realizadas intubações com o paciente acordado ou intubação de sequência rápida. Porém tal conceito baseia-se em um único trabalho da literatura, citado por diversos outros autores. O obeso também é considerado difícil de intubar, criando receio a respeito do sucesso da abordagem da via aérea. Os trabalhos da literatura, entretanto, contestam tais conceitos, o que leva ao questionamento das técnicas de acesso às vias aéreas. CONCLUSÕES: Os trabalhos da literatura mostram que o esvaziamento gástrico no obeso não é lentificado como se acreditava, assim como o conteúdo gástrico não é maior que no paciente não obeso; portanto, a intubação em plano anestésico pode ser realizada com segurança. Apesar de a obesidade, isoladamente, não causar falha na intubação, outros sinais podem ser usados para prever intubação difícil.

Palavras-chave

COMPLICAÇÕES, DOENÇAS, FISIOLOGIA; Gastrintestinal, INTUBAÇÃO TRAQUEAL, VENTILAÇÃO, VENTILAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The objective of this study was to review the literature and to question the concept that obese patients should be considered as having a potential full stomach and, therefore, question how the airways, considered as of difficult access due to obesity, should be approached during anesthetic induction. CONTENTS: Classically, obese patients are viewed as having a potential full stomach, leading to conducts to protect the airways during anesthetic induction. Frequently, awake intubation or rapid sequence intubation is performed. However, this concept is based on a single study, which has been cited by other authors. Obese patients are also considered difficult to intubate, raising the concern on the successful approach of the airways. However, studies in the literature question this concept, leading to questioning of the techniques used to access the airways. CONCLUSIONS: Studies in the literature demonstrate that gastric emptying is not slowed in obese patients as previously believed, and gastric contents are not greater in this patient population; intubation can, therefore, be safely done after anesthesia. Although obesity alone does not lead to failure to intubate, other signs can be used to predict difficult intubations.

Keywords

COMPLICATIONS, DISEASES, PHYSIOLOGY, Gastrointestinal, TRACHEAL INTUBATION, VENTILATION, VENTILATION

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