Page 11 - 麻醉与监护论坛2015年第12期

Anesthetic Management for an 126-kg Patient Undergoing
Inguinal Herniorrhaphy

Yong-chang Tan, Yan Luo

Department of Anesthesiology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai,

200025, China

Abstract

Background: The obesity in population is on the increasing trend in China. This epidemic has challenged the anesthesia, following the
physical changes caused by the disease.

Objective: To highlight some of the challenges, the management and the experience learnt during the management of this patient in the perioperative period.
Methods: This is a case report of a 21-year old male patient that presented for inguinal herniorrhaphy. Surgery was carried out under
general anesthesia with 2%sevofluranel and intravenous anesthetics.
Results: Under general anesthesia, standard monitored measures were performed in order to ensure his safety. Surgery was carried out successfully.
Conclusion: Better understanding of the patient condition and preoperative evaluation is beneficial to manage an obese patient during anesthesia.
Key Words: General anesthesia; Intravenous anesthetics; Inguinal herniorrhaphy; Difficult intubation; Obese patient
Corresponding Author: Yan Luo, E-mail: lyelectron@yahoo.com.cn

Introduction height 183cm (BMI=37.62). He is a university student with
good physical condition, and denied any systematic disease
The obesity in population is on the increasing trend in such as hypertension, diabetic mellitus, and cardiovascular
our country. Obesity can be defined as a “disease” because disease and so on. He had never undergone any operation
it is a physiologic dysfunction of the human organism with and taken any allergic things. He denied any use of alcohol
environmental, genetic, and endocrinologic causes[1]. Body and tobacco. Although all biochemical tests were normal,
mass index (BMI) was used most widely to assess the extent he had a short, thick neck, mallampati Ⅲ (only soft palate
of obesity[2]. It is defined as the patient’s weight divided by the could be seen) and mouth opening only two figures. The
square of patient’s height(weight[kg]/height² [m²]). According thyromental distance of he was 5cm. Above described physical
to the international diagnose criteria: the BMI is divided into conditions suggested difficult tracheal intubation. Chest-
five categories: <25 kg/m²= normal, 25-30 kg/m²= overweight, ray, ECG, echocardiography and respiratory function are in
>30kg/m²= obesity, >35kg/m² = morbid obesity, >55kg/m²= normal ranges. He can do normal daily activities without any
super morbid obesity[3]. The criterion of BMI in China is trouble. In general, intubation with consciousness may be
revised, however, because the differences between Asian and the best choice for the difficult airway patients. Based on the
non-Asian:24-27.9kg/m2=overweight; ≥28kg/m2 =obesity[4]. careful preoperational evaluation and abundant management
experience for bariatric surgery, we selected intravenous fast
The physical changes and implications accompanied induction as our first choice. We hope to secure safety of the
by obesity usually caused the challenges to anesthesia. Such patient, meanwhile, and provide a comfortable anesthesia.
challenges include insulin resistance, type 2 diabetes mellitus,
hypertension, hypoventilation, cardiovascular disease and After entering the operating room, intravenous access and
difficult airway[5-7]. Some experts argue that obese patients standard monitoring was established. Midazolam 4mg and
have a higher incidence of difficult tracheal Intubation[8,9]. dexamethasone 10mg were used as premedication. Anesthesia
For example, the weight over 95kg is considered as a risk of was induced while the patient was in a supine position.
difficult tracheal intubation[10]. But there is no agreed standard Oxygen saturation (SpO2) was 98% in room air before
of it in clinical. Obesity will influence the pharmacokinetics induction. Three anesthesiologists anesthetized this patient
of the anesthetics such as expanding highly lipid soluble lest endotracheal intubation lead to some troubles endangered
anesthetics VD (volume of distribution)[11] and reducing the patient. Taking full account of his intubation condition
clearance rate[12]. Based on such complicated states, careful evaluated before the surgery, we decided to use shikani optical
and precise preoperative evaluation and optical anesthesia stylet to reduce the risk. Under inhalation of oxygen 6.0/
management are the foundations of the surgery success. min by a mask and preparation of ephedrine and atropine,
anesthesia induced with fentanyl 0.2mg, propofol 300mg and
Case report cisatracurium 25mg. As the patient eyelash reflexes vanished,
preoxygenation and mask ventilation was performed. One
A 21-year-old obese male patient presented for inguinal anesthesiologist maintained the airway and another squeezed
herniorrhaphy under general anesthesia. The preoperative
evaluation showed the total body weight is 126kg and a

Laboratory and Clinical Investigation 119 FAM 2013 Mar/Apr Vol.20 Issue 2
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