Laparoscopic_Surgery_in_Obese_Patients.pptx

Laparoscopic surgery in obese patient

1. Laparoscopic Surgery in Obese Patients Emphasis on Anaesthetic Concerns and General Case Presentation Dr. Singasani Shreeja

2. Introduction Obesity poses unique challenges in laparoscopic surgery. It affects respiratory mechanics, cardiovascular function, and anaesthetic management.

3. Definition and Classification Obesity defined as BMI >30 kg/m². Class I: 30–34.9 Class II: 35–39.9 Class III: ≥40 (morbid obesity).

4. Epidemiology and Indications Rising prevalence globally. Common laparoscopic procedures: cholecystectomy, appendectomy, hernia repair, bariatric surgery.

5. Physiological Changes in Obesity Respiratory: ↓FRC, ↓compliance, ↑O₂ consumption. Cardiac: ↑CO, ↑LV workload, risk of HTN and CAD. Metabolic: insulin resistance, fatty liver.

6. Anaesthetic Challenges 1. Difficult airway 2. Rapid desaturation 3. IV access difficulty 4. Drug dosing uncertainty 5. Positioning and ventilation challenges.

7. Preoperative Assessment Evaluate comorbidities (OSA, DM, HTN, CAD). Assess airway (Mallampati, neck circumference). Optimize weight and control diseases.

8. Airway Management Anticipate difficult intubation. Ramped position preferred. Use video laryngoscope, fiberoptic if needed.

9. Intraoperative Concerns Pneumoperitoneum causes ↑PaCO₂, ↓venous return. Trendelenburg increases airway pressure. Use low tidal volume, PEEP, and monitoring of EtCO₂.

10. Anaesthetic Drugs & Dosing Use lean body weight or adjusted body weight for dosing. Avoid excessive sedation. Use short-acting agents (propofol, desflurane).

11. Positioning & Monitoring Reverse Trendelenburg with leg supports. Arterial line in high-risk patients. Capnography, temperature, and neuromuscular monitoring essential.

12. Postoperative Management Extubate fully awake. Use CPAP in OSA. Encourage early ambulation and thromboprophylaxis.

13. Advantages of Laparoscopy Less pain, early ambulation, lower wound infection, reduced hospital stay compared to open surgery.

14. Limitations / Risks Technical difficulty, longer operative time, increased intra-abdominal pressure risk.

15. Case Presentation A 45-year-old female, BMI 38, ASA III. Planned laparoscopic cholecystectomy. Preop optimization done. Ramped position used for intubation. Procedure uneventful.

16. Discussion Key considerations: difficult airway, high airway pressures, and oxygenation strategy. Good planning ensures safety and smooth recovery.

17. Conclusion Obese patients require meticulous anaesthetic planning for laparoscopic surgery. Multidisciplinary approach improves outcomes.

18. References 1. Miller’s Anaesthesia, 9th ed. 2. Morgan & Mikhail, Clinical Anaesthesiology, 7th ed. 3. Br J Anaesth. 2019;122(5):e45–e57.