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

Referencias

Wright RA, Krinsky S, Fleeman C, Trujillo J, Teague E. Gastric emptying and obesity. Gastroenterology. 1983;84:747-751.

Vaughan RW, Bauer S, Wise L. Volume and pH of gastric juice in obese patients. Anesthesiology. 1975;43:686-789.

Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesth Analg. 1974;53:859-768.

Schreiner MS. Gastric fluid volume: is it really a risk factor for pulmonary aspiration?. Anesth Analg. 1998;87:754-756.

Amaral CRT, Cheibud ZB. Obesidade mórbida: implicações anestésicas. Rev Bras Anestesiol. 1991;41:273-279.

Shenkman Z, Shir Y, Brodsky JB. Perioperative management of the obese patient. Br J Anaesth. 1993;70:349-359.

Oberg B, Poulsen TD. Obesity: an anaesthethic challenge. Acta Anaesthesiol Scand. 1996;40:191-200.

Buckley FP, Martay K. Anesthesia and obesity and gastrointestinal disorders. Clinical anesthesia. 1997:975-989.

Romaneck RM, Lopes Jr C, Miranda MM. Anestesia e analgesia pós-operatória para cirurgia bariátrica. Atual Anestesiol SAESP. 2004;9:135-161.

Harter RL, Kelly WB, Kramer MG. A comparison of the volume and ph of gastric contents of obese and lean surgical patients. Anesth Analg. 1998;86:147-152.

Juvin P, Fevre G, Merouche M. Gastric redisue is not more copious in obese patients. Anesth Analg. 2001;93:1621-1622.

Maltby JR, Pytka S, Watson NC. Drinking 300 ml of clear fluid two hours before surgery has no effect on gastric fluid volume and ph is fasting and non-fasting obese patients. Can J Anaesth. 2004;51:111-115.

Illing L, Duncan PG, Yip R. Gastroesophageal reflux during anaesthesia. Can J Anaesth. 1992;39:466-470.

Huxley EJ, Viroslav J, Gray WR. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978;64:564-568.

Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth. 1999;83:453-460.

Smith KJ, Dobranowski J, Yip G. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology. 2003;99:60-64.

Ogunnaike BO, Whitten CW. Anesthesia and obesity. Clinical anesthesia. 2006:1040-1052.

Berthoud MC, Peacock JE, Reilly CS. Effectiveness of preoxygenationi in morbidly obese patients. Br J Anaesth. 1991;67:464-466.

Reber A, Engberg G, Wegenius G. Lung aeration: the effect of pre-oxygenation and hyperoxygenation during total intravenous anesthesia. Anesthesia. 1996;51:733-737.

Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. Surv Anesthesiol. 2002;46:40-42.

Wilson ME, Spiegelhalter D, Robertson LA. Predicting difficult intubation. Br J Anaesth. 1988;61:211-216.

Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85:91-108.

Buckley FP, Robinson NB, Simonowitz DA. Anaesthesia in mordidly obese: A comparison of anaesthetic and analgesic regimens for upper abdominal surgery. Anaesthesia. 1983;38:840-851.

Juvin P, Lavaut E, Dupont H. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97:595-600.

Shiga T, Wajima Z, Inoue T. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103:429-437.

Shiga T, Wajima Z, Inoue . Predicting difficult intubation. Anesthesiology. 2006;104:618-619.

Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth. 1994;41:372-383.

Karkouti K, Rose DK, Wigglesworth D. Predicting difficult intubation: a multivariable analysis. Can J Anaesth. 2000;47:730-739.

Brodsky JB, Lemmens HJM, Brock-Utne JG. Morbid obese and tracheal intubation. Anesth Analg. 2002;94:732-736.

Ezri T, Medalion B, Weisenberg M. Increase body mass index per se is not a predictor of difficult laryngoscopy. Can J Anaesth. 2003;50:179-183.

Cattano D, Panicucci E, Paolicchi A. Risk factors assessment of the difficult airway: an italian survey of 1956 patients. Anesth Analg. 2004;99:1774-1779.

Collins JS, Lemmens HJM, Brodsky JB. Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions. Obes Surg. 2004;14:1171-1175.

Collins JS, Lemmens HJM, Brodsky JB. Obesity and difficult intubation: where is the evidence?. Anesthesiology. 2006;104.

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