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2016, Número 1

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Rev Mex Anest 2016; 39 (1)


Cirugía bariátrica. Consideraciones anestésicas cardiopulmonares en bypass gástrico laparoscópico

Gómez-Ríos N, Rodríguez-Ortega F, Lozano-Corona R, Victoria-Campos JL, Negrete-Rivera MA, Fernández-Rivera BJ

Idioma: Español
Referencias bibliográficas: 164
Paginas: 30-49
Archivo PDF: 319.24 Kb.


RESUMEN

Objetivo: Reportar el tratamiento anestésico perioperatorio y las implicaciones cardiopulmonares en los pacientes con obesidad mórbida tratados con bypass gástrico por vía laparoscópica. Sede: Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). Diseño: Retrospectivo, observacional, longitudinal y descriptivo. Análisis estadístico: Porcentaje como medida de resumen para variables cualitativas. Material y métodos: Entre junio de 2009 y junio de 2015 se revisaron los expedientes de 116 pacientes con diagnóstico de obesidad mórbida candidatos a cirugía bariátrica y seleccionados para bypass gástrico por vía laparoscópica, analizando las siguientes variables: edad y género, tratamiento anestésico, implicaciones cardiopulmonares y morbimortalidad. Resultados: 116 pacientes se incluyeron en el estudio, 92 del género femenino, edad, peso e índice de masa corporal promedio de 40 años, 124.4 kg y 45.5 kg/m2. Con las siguientes comorbilidades: hipertensión arterial sistémica 71 pacientes y diabetes mellitus 70. Se utilizó presión positiva en vía aérea preoperatoria en cuatro. Utilizando las escalas de OBESE, OS-MRS, STOP-BANG y HAN para valoración preoperatoria anestésica. En cuanto al tratamiento preanestésico se administró propofol en 109 pacientes, fentanyl en 101, rocuronio en 32 y sevoflurano en 93. Además, se utilizó mascarilla laríngea de intubación (Fastrach®) en cuatro y fibrobroncoscopía en siete. En el período trans- y postoperatorio se diagnosticaron 49 pacientes con arritmias y atelectasias en 41. En el período postquirúrgico para extubación se realizó antagonismo con neostigmina en 12 pacientes y se utilizó presión positiva de la vía aérea en ocho (cuatro preoperatorio y cuatro postextubación), se reintubaron en sala de quirófano cuatro; infiltración con anestésico local al 100% en el sitio de incisión. Con adecuada evolución postquirúrgica anestésica a 12 meses de seguimiento. Conclusión: El incremento en las salas de quirófano de este tipo de pacientes, hace necesaria la preparación adecuada del médico anestesiólogo, para llevar a cabo un tratamiento integral y multidisciplinario.


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