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Послеоперационный уход. Послеоперационная кислородная терапия может снизить риск гипоксии, которая в свою очередь, снижает риск инфекции

Послеоперационная кислородная терапия может снизить риск гипоксии, которая в свою очередь, снижает риск инфекции. С целью профилактики легочных и тромбоэмболических осложнений родильницы с ожирением должны быть активированы в кратчайшие сроки. Должна быть организованна физиотерапия и матрацы с переменным давлением для предотвращения пролежней. Наряду с ранней активацией пациентки, для предотвращения тромботических/тромбоэмболических осложнений дополнительно применяются фармакологические и механические методы профилактики.

Резюме

Ожирение связано со многими физиологическими изменениями, которые снижают адаптационные возможности организма во время беременности и родов. Беременные с ожирением относятся к группе высокого риска по развитию тяжелых осложнений. Анестезиолог должен приложить все усилия для проведения безопасного и комфортного родоразрешения женщин с ожирением на протяжении всего периода нахождения пациентки в родильном отделении. Акушерская и анестезиологическая тактика ведения пациенток с ожирением должна быть определена заранее. Анестезиологическая бригада должна обладать достаточным опытом и необходимым оборудованием. Скоординированный подход команды, взаимопонимание между анестезиологом, акушером, медсестрой и пациенткой, облегчит медицинское пособие, минимизирует анестезиологический и акушерский риск.

Литература:

1. ACOG Committee Opinion number 315. Obesity in pregnancy. Obstet Gynecol. 2005; 106: 671-5.

2. CMACE/RCOG Joint Guideline Management of women with obesity in pregnancy. 2010.

3. Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Clinical Strategy and Programmes Directorate, Health Service Executive obesity and pregnancy clinical practice guideline. Guideline No. 2. 2011.

4. Coassolo K.M, Tiedeken K. Obesity in Pregnancy. The Female Patient. 2010; 35(1): 22-5.

5. Davies G.A., Maxwell C., McLeod L.et al. Obesity in pregnancy. J. Obstet. Gynaecol. Can. 2010; 32 (2): 165-73.

6. Garrison A.W. Obesity in Pregnancy. Am Fam Physician. 2013; 87 (9): 606.

7. Obesity in pregnancy. SOGC Clinical Practice Guideline No. 239. Journal of Obstetrics and Gynaecology Canada. 2011; 32 (2): 165-73.

8. Poobalan A.S., Aucott L.S., Gurung T. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women-systematic review and meta-analysis of cohort studies. Obes. Rev. 2009; 10 (1): 28-35.

9. WHO. Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. Geneva: World Health Organisation. 1998.

10. O’Brien T.E., Ray J.G., Chan W.S. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epedemiol. 2003; 14: 368-74.

11. Vasudevan A. Pregnancy in patients with obesity or morbid obesity: obstetric and anesthetic implications. Bariatric Times. 2010; 7 (7): 9-13.

12. Wagner W.E. Сritical care risk in the pregnancy complicated with obesity. Focusing on perinatal and neonatal issues. 2010; 11 (1): 145-59.

13. Strum E.M., Szenohradszki J., Kaufman W.A. Emergence and recovery characteristics of desflurane versus sevoflurane in morbidly obese adult surgical patients: a prospective, randomized stude. Anesth. Analg. 2004; 99: 1848-53.

14. Soens M.A., Birnbach D.J., Ranasinghe J.S., van Zundert A. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta. Anaesth. Scand. 2008; 52 (1): 6-19.

15. Shenkman Y.S., Brodsky J.B. Perioperative Management of the Obese Patient. Br. J. Anaesth. 1993; 70: 349-59.

16. Schulzeck S., Gleim M., Palm S. Anesthesia for cesarean section of obese women. Results of a four-year observation. Anaestht. 2003; 52 (9): 787-94.

17. Saravanakumar K., Rao S.G., Cooper G.M. Obesity and obstetric anaesthesia. Anaesth. 2006; 61 (1): 36-48.

18. Roofthooft E. Anesthesia for the morbidly obese parturient. Curr. Opin. Anaesth. 2009; 22 (3): 341-6.

19. Chu S.Y., Kim S.Y., Schmid C.H., Dietz P.M., Callaghan W.M., Lau J., et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes. Rev. 2007; 8 (5): 385-94.

20. Cooper G.M., McClure J.H. Anaesthesia chapter from saving mothers' lives: reviewing maternal deaths to make pregnancy safer. Br. J. Anaesth. 2008; 100 (1): 17-22.

21. Bamgbade O.A., Khalaf W.M., Ajai O. Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study. Int. J. Obstet. Anesth. 2009; 18 (3): 221-5.

22. Edomwonyi N.P., Osaigbovo P.E. Incidence of obesity in parturients scheduled for caesarean section, intra-operative complications, management and outcome. East Afr. Med. J. 2006; 83 (4): 112-9.

23. Leykin Y., Pellis T. Pathophysiological and perioperative features of morbidly obese parturients. Obstet. Gynecol. 2009; 4 (3): 313-9.

24. Royal College of Obstetricians and Gynaecologists. Green-Top Guideline No. 37 a. Reducing the risk of thrombosis and embolism during pregnancy and puerperium. London: Royal College of Obstetricians and Gynaecologists, 2009; 35.

25. Sia A.T., Fun W.L., Tan T.U. The ongoing challenges of regional and general anaesthesia in obstetrics. Best Pract. Res. Clin. Obstet. Gynaecol. 2010; 24 (3): P. 303-12.

26. Singh S., Chaudry S.Y., Phelps A.L., Vallejo M.C. A 5-year audit of accidental dural punctures, postdural puncture headaches, and failed regional anesthetics at a tertiary-care medical center. Scientific World J. 2009; 9: 715-22.

27. Rosito G.A., D’Agostino R.B., Massaro J. Association between obesity and the prothrombotic state: the Framington Offspring Study. Thromb. Haemost. 2004; 91: 683-9.

28. Torloni M.R., Betrán A.P., Horta B.L., Nakamura M.U., Atallah A.N., Moron A.F. et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes. Rev. 2009; 10 (2): 194-203.

29. The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. U.S. Department of Health and Human Services Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute NIH Publication No. 00-4084. October 2000.

30. Satpathy H.K., Fleming A., Frey D. Maternal obesity and pregnancy. Postgrad Med. 2008; 120 (3): 1-9.

31. Jadon A. Complications of regional and general anaesthesia in obstetric practice. Indian J. of Anaesth. 2010; 54 (5): 415-20.

32. Lynch J., Scholz S. Anaesthetic-related complications of caesarean section. Entralbl. Gynakol. 2005; 127 (2): 91-5.

33. Bodnar L.M., Kaufman J.S. Maternal body mass index and the risk of preeclampsia [letter]. Epidemiology. 2004; 15 (2): 252-3.

34. Bourjeily G., Paidas M., Khail H., Rosene-Montella K., Rodger M. Pulmonary embolism in pregnancy. Lancet. 2010; 375: 500-12.

35. Chu S.Y., Kim S.Y., Lau J. Re: Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes. Rev. 2009; 10 (4): 487-8.

36. Heslehurst N., Simpson H., Ells L.J., Rankin J., Wilkinson J., Lang R., et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes. Rev. 2008; 9 (6): 635-83.

37. Jacobsen A.F., Skjeldestad F.E., Sandset P.M. Ante- and postnatal risk factors of venous thrombosis: a hospitalbased case control study. J. of Thrombosis and Haemostasis. 2008; 6 (6): 905-12.

38. Nortcliffe S.A. Obstetric anaesthesia & Obesity. Anaesth. 2009; 7: 1-8.

39. Orbach-Zinger S., Friedman L., Avramovich A. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta. Anaesth. Scand. 2006; 50 (8): 1014-8.

40. Panni M.K., Columb M.O. Obese parturients have lower epidural local anaesthetic requirements for analgesia in labour. Br. J. Anaesth. 2006; 96: 106-10.

41. Gautam P.L., Kathuria S., Kaul T.K. Infiltration block for caesarean section in a morbidly obese parturient. Acta. Anaesth. Scand. 1999; 43: 580-1.

42. Bhattacharya S., Campbell D.M., Liston W.A., Bhattacharya S. Effect of Body Mass Index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public. Health. 2007; 24 (7): 168.

43. Brodsky J.B. Anesthesia for bariartric surgery. American Society of Anesthesiology 2005 Annual Meeting, 56th ed. Atlanta, Georgia: Lippincott Williams & Wilkins. 2005; 1-7.

44. Djabatey E.A, Barclay P.M. Difficult and failed intubation in 3430 obstetric general Anaesthetics. Anaesth. 2009; 64: 1168-71.

45. Brodsky J.B., Lemmens H.J., Brock-Utne J.G. Anesthetic considerations for bariartric surgery: proper positioning is important for laryngoscopy. Anesth. Analg. 2003; 96: 1841-2.

46. Sprung J., Whalley D.G., Falcone T. The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Anesth. Analg. 2003; 97: 268-74.

47. Saravanakumar K., Rao S.G., Cooper G.M. The challenges of obesity and obstetric anaesthesia. Curr. Opin. Obstet. Gynecol. 2006; 18 (6): 631-5.

48. Mhyre J.M. Anesthetic management for the morbidly obese pregnant woman. Int. Anesthesiol. Clin. 2007; 45 (1): 51-70.

49. Bjornestad E., Rosseland L.A. Anaesthesia for Caesarean section. Tidsskr Nor Laegeforen. 2010; 130 (7): 748-51.

50. Yentis S. Height of confusion: assessing regional blocks before caesarean section. Int. J. Gynaecol. Obstet. 2006; 15: 2-6.

51. Bromage P.R. Neurologic Complications of Regional Anaesthesia for Obstetrics. In: Hughes S.C., Levinson G., Rosen M.A. (eds.) Shnider and Levinson's Anesthesia for Obstetrics., editors. 4 th ed. USA: Lippincott Williams and Wilkins Philadelphia. 2002; 409-16.

52. Clinkscales C.P., Greenfield M.L., Vanarase M., Polley L.S. An observational study of the relationship between lumbar epidural space depth and body mass index in michigan parturients. Int. J. Anesth. Obstet. 2007; 16 (4): 323-7.

53. Grau T., Leipold R.W., Horter J. The lumbar epidural space in pregnancy: visualization by ultrasonography. Br. J. Anaesth. 2001; 86: 798-804.

54. Gross J.B., Bachenberg K.L., Benumof J.L. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American society of anesthesiologists task force on perioperative management of patients with obstructive sleep apnea. Anesth. 2006; 104 (5): 1117-8.

55. Dixon B.J., Carden J.R. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesth. 2005; 102: 1110-5.

56. Pandit J.J., Duncan T., Robbins P.A. Total oxygen uptake with two maximal breathing techniques and the tidal volume breathing technique: a physiologic study of preoxygenation. Anesth. 2003; 99: 841-6.

57. von Ungern-Sternberg B.S., Regli A., Bucher E. Impact of spinal anaesthesia and obesity on maternal respiratory function during elective caesarean section. Anaesthesia. 2004; 59: 743-9.

58. Pearson K.S., From R.P., Kirshner B.S., Sokoll M.D. Pharmacodynamics of Org. 9426 in obese patients. Anesth. Analg. 1993; 76: 327.

59. Puhringer F.K., Khuenl-Brady K.S., Mitterschiffthaler G. Rocuronium bromide: time-course of action in underweinght, normal weight, overweight and obese patients. Eur. J. Anaesth. 1995; 12 (11): 107-10.

60. Roest G., Rietbergen H. Rocuronium in obstetrical anesthesia: pharmacokinetics, placental transfer and intubating condition. Ibid. 1996; 5 (4): 897.

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