Ilustrasi Kasus 3

[narscha]

A 37-year-old woman presents for weight loss surgery. She is 5 ft 3 in and 245 lb, yielding a BMI (body mass index) of 43.4 kg/m2. She has tried for many years to lose weight through diet and exercise without success. She has a history of hypertension treated with lisinopril, type II diabetes mellitus controlled with metformin, gastroesophageal reflux disease (GERD) well-controlled with omeprazole, and her husband states that she snores at night. She has no allergies, no family history of problems with anesthesia, and has never had surgery before. After discussion with her surgeon, she is electing to have a laparoscopic gastric banding procedure.

➤ What additional history would be helpful in the management of this patient?
➤ What preoperative testing should be done?
➤ How will you manage her airway?
➤ How can her postoperative pain be safely and effectively controlled?

Comprehension Questions
1. Which of the following is an important test for patients with suspected OSA prior to weight loss surgery?
A. Complete blood count (CBC)
B. Electrolytes
C. Chest x-ray
D. Polysomnography
E. Exercise stress test

2. Morbidly obese patients have which of the following alterations in respiratory physiology?
A. Reduced FRC
B. Reduced peak inspiratory pressures
C. Increased lung volumes
D. Increased chest wall compliance

3. Which of the following medications should be dosed according to total body weight (TBW), instead of lean body mass in morbidly obese patients?
A. Morphine PCA
B. Vecuronium
C. Succinylcholine
D. Pancuronium