Anaesthesia in obese patients

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  • Anaesthesia in obese patients
You are examining Mr. X (male, 117 kg/187 cm, BMI 33,5) who is about to undergo a total knee replacement surgery. He is being treated for arterial hypertension and DM, both are well compensated. What kind of premedication would you prescribe for him?

20 mg of omeprazole and 10 mg of hypnogen perorally in the evening before surgery. 20 mg of omeprazole combined with 10 mg of metoclopramide, 7,5 mg of midazolam perorally and 0,5 mg of atropine IM.

Correct answer

We have to treat an obese patient as if he was not on an empty stomach, therefore it is necessary to administer metoclopramide and omeprazole to eliminate GER (gastroesophageal reflux). Atropine prevents bradycardia in the beginning of anaesthesia and minimizes saliva production.


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We administer the usual premedication (hypnogen in the evening before surgery, midazolam in the morning) in increased dose due to patient’s weight.

Wrong answer

Although benzodiazepines are administered in this case, we use normal dose. Increased doses can lead to sleep apnea. We also have to prevent GER (gastroesophageal reflux) in obese patients with omeprazole and metoclopramide.


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We administer the usual premedication (hypnogen in the evening before surgery, midazolam in the morning). It is not necessary to increase the dose for obese patients.

Wrong answer

Benzodiazepines are administered in normal dose, but we have to remember the risk of GER (gastroesophageal reflux) in obese patients and prevent it omeprazole and metoclopramide. Atropine prevents bradycardia in the beginning of anaesthesia and minimizes saliva production.


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Help

DM = diabetes mellitus
BMI = body mass index×
 
RR

12 bpm

HR

75 bpm

SpO2

98 %

BP

135/80 mmHg

ECG

sinus rythm, regular pace, BPM 75 bpm

 

Gly

results

ABG

not available

CBC

results

biochemistry

results