A 17-year-old girl was admitted with "abnormal uterine bleeding, obesity, severe anemia, thrombocytopenia"**. The patient has no previous underlying medical history, but the patient is admitted to the hospital with heavy bleeding.
Admission check HB39G L, RBC12 1012 l, platelets 54 109 l. The patient is obese and weighs up to 163 kg. After being admitted to the hospital, correction of anemia and platelet transfusion** were given, and "hysteroscopy" was prepared.
The anesthesiologist visits the patient before surgery, and the patient is severely obese. Patients with anemia, low platelets, and unclear lumbar and back intervertebral spaces should be considered for combined spinal-epidural puncture or epidural puncture, as repeated puncture may fail or there is a risk of epidural hematoma.
Patients are given local anesthesia and should not be tolerated by patients. If general anesthesia is performed, the patient's airway is graded grade II, and intravenous general anesthesia faces many risks, such as high-risk factors for OSAHS, and the patient's abdominal fat is thick, can the patient maintain normal breathing during the operationIf breathing is not sustainable, can a laryngeal mask or endotracheal tube be used?Can the patient be extubated after surgery and will he need to be admitted to the ICU?
According to the requirements of modern anesthesiology, the patient's head is high before surgery, and a video laryngoscope, a fiberscope, a laryngeal mask, an anesthesia machine, and a suction device are prepared, and there are more than 2 senior anesthesiologists. The patient's corrected weight was calculated, ABW=IBW+04 [TBW-IBW], patient-corrected weight 102 kg.
After the patient entered the room, he was monitored, and the arterial puncture was done, and the blood gas pH was 7 for the first time452，hb7.7g/l，glu7.7mmol/l，pco235mmhg。Give 0 with caution1mg fentanyl, 150mg propofol was slowly pushed intravenously, the patient was sedated, spontaneously breathing, propofol was continuously pumped during the operation, and the monitoring indicators were closely observed, the hemodynamic force was stable during the operation, and the patient was given jaw lifting treatment when the patient was depressed in breathing.
After the operation, the patient was awake, with normal blood pressure, heart rate, and oxygenation, and returned to the ward after entering the recovery room.
For surgery in severely obese patients, regional tissue may be preferred as a preferred option over general anesthesia if available. If sedation is to be combined, the depth of sedation should be kept to a minimum and closely monitored. Obesity is intolerant to supine or head-down positions, and hypotension and hypoxemia should be suspected. If general anesthesia is used, general anesthesia is risky for obese patients, and the anesthesia plan is discussed with the patient and surgeon in detail before surgery, including all risks, advantages, and alternatives to general anaesthesia. The possibility of postoperative mechanical ventilation for respiratory support should also be discussed.
Author: Dunin.
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