ABSTRACT
Introducción: Se considera la obesidad una enfermedad en auge, con una presencia cada vez mayor de pacientes obesos en las áreas quirúrgicas. El tratamiento quirúrgico de dicha enfermedad ha variado en los últimos años, aumentando las técnicas menos invasivas y las terapias puente a la cirugía, como es el balón intragástrico. Objetivos:Realizar un repaso de las implicaciones anestésicas y de la fisiopatología de la obesidad, así como de las diferentes opciones quirúrgicas para la reducción de peso. Material y métodos:Presentamos el caso clínico de un paciente súper-superobeso propuesto para la implantación de un balón intragástrico bajo sedación anestésica. Conclusiones:Las técnicas quirúrgicas para la cirugía de la obesidad tienden a ser cada vez menos agresivas, siendo fundamental el trabajo multidisciplinar para el mejor tratamiento de estos pacientes. El anestesiólogo juega un papel muy importante en el perioperatorio para el éxito de este tipo de procedimientos.
Introduction: Obesity is considered a booming disease with increasing numbers of obese patients undergoing surgery. Surgical treatment of obesity has changed over the last few years with less invasive techniques and pre-surgery therapeutic approaches such as the intragastric balloon. Objectives: To complete an overview of the anesthetic implications and the pathophysiology of obesity and of the various surgical options for weight loss. Material and methods: This is a clinical case of a super-super obese patient scheduled for intra-gastric balloon implantation under anesthetic sedation. Conclusions: Surgical techniques for obesity procedures tend to be increasingly less aggressive. A multidisciplinary approach is critical for providing the best care of these patients and the anesthesiologist plays a key role during the perioperative period for the success of these procedures.
Subject(s)
HumansABSTRACT
This is the first study to use fNIRS to explore anaesthetic depth and awakening during surgery with general anaesthesia. A 16 channel continuous wave (CW) functional near-infrared system (fNIRS) was used to monitor PFC activity. These outcomes were compared to BIS measures. The results indicate that deoxyHb concentration in the PFC varies during the suppression and emergence of consciousness. During suppression, deoxyHb levels increase, signalling the deactivation of the PFC, while during emergence, deoxyHb concentration drops, initiating PFC activation and the recovery of consciousness. Furthermore, BIS and deoxyHb concentrations in the PFC display a high negative correlation throughout the different anaesthetic phases. These findings suggest that deoxyHb could be a reliable marker for monitoring anaesthetic depth, and that the PFC intervenes in the suppression and emergence of consciousness.
