Vorotyntsev S. Anaesthesia and perioperative intensive care in obese patients

In the study it is presented the solution of the current problem of modern anesthesiology - improvement of safety and efficiency of surgical treatment of patients with concomitant obesity by developing a comprehensive program of perioperative care on the basis of improvement of preoperative assessment of patients, optimization of anesthetic support technologies for surgical interventions and postoperative intensive care. Based on the results of the study, a perioperative safety program for obese patients in abdominal surgery has been improved. It consists of: preoperative risk assessment using the ACS-NSQIP calculator and the MET score; use of ultrasound for catheterization of internal jugular vein and epidural space, performance of TAP-block and RSB; blind awake intubation of the trachea through the supraglottic airway devices using the indirect laryngoscopy technique of local anaesthesia; appliance of volemic fluid loading of 6 ml/kg (IBW) before induction of anaesthesia; use of the nasopharyngeal airway device for apneic oxygenation; choosing of combined inhalation-epidural anaesthesia or multimodal anaesthesia/analgesia for laparotomy surgery (RSB - according to indications); choosing of inhalation anaesthesia or total intravenous anaesthesia for laparoscopic surgery (epidural analgesia, TAP-block, dexmedetomidine - according to indications); intraoperative prescription of balances solutions directed to stroke volume support; the use of capnometry continuously at least 2 hours after the surgery; coagulation control using the method of low-frequency piezoelectric thromboelastography. The effectiveness of using this program is proven.