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Anesthesia in Obese Children

Year 2020, Volume: 4 Issue: 1, 40 - 51, 09.03.2020
https://doi.org/10.33716/bmedj.678177

Abstract

In this review, information on the definition, epidemiology, etiology, pathophysiology, pharmacology and treatment of childhood obesity, and anesthetic management will be reviewed in the light of the literature.
Some objectives were aimed at preparing the compilation;
1- To eliminate the myths that obesity is rare in pediatric patients, each country thinks only obesity in itself and that child obesity does not have long-term side effects.
2- To sensitize anesthesiologists against childhood obesity, called “pandemic of the new millennium”, to a problem rarely addressed in the literature.

Project Number

yok

References

  • 1- Saka N, Akçay T.Çocuk Endokrinolojisi ve Diyabet Derneği- Çocuk endokrinolojisinde uzlaşı. Çocuk Endokrinolojisi Diyabet derneği Yayınları-V: 171-181. 2- Owen J, John R. Childhood obesity and the anaesthetist. Continuing Education in Anaesthesia, Critical Care & Pain 2012; Volume 12 Number 4: 169-175. 3- Nafiu O, Curcio C. Simplified table to identify overweight and obese children undergoing anesthesia. Pediatric Anesthesia 2013; 23: 962–970. 4- Lobstein T, Jackson-Leach R, Lmoodie M, Dhall K, Lgortmaker S, swinburn B, James P, Wang Y, McPherson K. Child and adolescent obesity: part of a bigger pictureVolume 385, Issue 9986, 20–26 June 2015, Pages 2510-2520, https://doi.org/10.1016/S0140-6736(14)61746-3 5- ÇATLI G, BÜYÜKGEBİZ A. Çocuk ve Ergenlerde Obezite: Tanım ve Epidemiyoloji Turkiye Klinikleri J Pediatr Sci. 2015;11(3):7-21 6- Jeyakumar A, Fettman N, Armbrecht ES, Mitchell R. A systematic review of adenotonsillectomy as a risk factor for childhood obesity. Otolaryngol Head Neck Surgery 2011; 144(2): 154-8. 7-Lustig RH., Post SR., Srivannaboon K., Rose SR., Danish RK., Burghen GA.,Xiong X., Wu S., Merchant TE. Risk Factors for the Development of Obesity in Children Surviving Brain Tumors. The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 2, 1 February 2003, Pages 611–616, https://doi.org/10.1210/jc.2002-021180 8- Nafiu O, Green GE., Walton SA., Morissa M., Reddy S., Tremper K. Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy. International Journal of Pediatric Otorhinolaryngology 2009 Volume 73, Issue 1: Pages 89-95, https://doi.org/10.1016/j.ijporl.2008.09.027 9- Chidambaran V., Tewari A., Mahmoud M. Anesthetic and pharmacologic considerations in perioperative care of obese children. Journal of Clinical Anesthesia Volume 45, March 2018, Pages 39-50. https://doi.org/10.1016/j.jclinane.2017.12.016. 10- Raghavan K., Moo Y., Tan Z. Severe obesity in children as an independent risk factor for perioperative respiratory adverse events during anaesthesia for minor non-airway surgery, a retrospective observational study Proceedings of Singapore Healthcare 2019 Vol 28, Issue 2.. https://doi.org/10.1177/2010105818802994 11- Ladosky W., Botelho MAM., Albuquerquejr J. Chest mechanics in morbidly obese non-hypoventilated patients. Respiratory Medicine April 2001 Volume 95, Issue 4; 281-286. 12- Lang JE., Feng H., Lima JJ.,, Harmd P. Body Mass Index-Percentile and Diagnostic Accuracy of Childhood Asthma Journal of Asthma 2009;46:291–299.DOI: 10.1080/02770900802712963 13- Verhulst SL., Aerts L, Jacobs S., Schrauwen N., Haentjens D., Claes R.,Vaerenberg H., Van Gaal LF., De Backer WA, Desager KN. Sleep-Disordered Breathing, Obesity, and Airway Inflammation in Children and Adolescents Chest 2008; 134:1169-1175 14- Li X., Li S., Ulusoy E., Chen W., Srinivasan SR., Berenson GS. Childhood Adiposity as a Predictor of Cardiac Mass in Adulthood The Bogalusa Heart Study. Circulation. 2004;110:3488-3492. DOI: 10.1161/01.CIR.0000149713.48317.27 15- Gidding SS., Nehgme R., Heise C., Muscar C., Linton A., Hassink S. SEVERE OBESITY ASSOCIATED WITH CARDIOVASCULAR DECONDITIONING, HIGH PREVALENCE OF CARDIOVASCULAR RISK FACTORS, DIABETES MELLITUS/HYPERINSULINEMIA, AND RESPIRATORY COMPROMISE. J Pediatr 2004;144:766-9 16- Martini G., Riva P., Rabbia F., Molini V., Ferrero GB., Cerutti F., Carra R.,Veglio F. Heart rate variability in childhood obesity. ClinicalAutonomic Research 2001, 11:87-91 17-Tounian P., Aggoun Y., Dubern B., Varille V., Guy-Grand B., Sidi D., Girardet JP., Bonnet D. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001; 358: 1400–04 18- Sinha A., Kling S. A Review of Adolescent Obesity: Prevalence, Etiology, and Treatment. OBES SURG (2009) 19:113–120 DOI 10.1007/s11695-008-9650-4 19- Craig, M. E., Hattersley, A., & Donaghue, K. C. (2009). Definition, epidemiology and classification of diabetes in children and adolescents. Pediatric Diabetes, 10, 3–12.doi:10.1111/j.1399-5448.2009.00568.x. 20- Association, A. D. (2000).Type 2 Diabetes in Children and Adolescents. Pediatrics, 105(3), 671–680.doi:10.1542/peds.105.3.671. 21- Vaughan RW., Bauer S., Wise L. VOLUME AND PH OF GASTRIC JUICE IN OBESE PATIENTS. ANESTHESIOLOGY; U.S.A.; DA. 1975; VOL. 43; NO 6; PP. 686-689. 22- Borland LM., Sereika SM., Woelfel SK., Saitz EW., Carrillo PA., Lupin JL., Motoyama EK. Pulmonary Aspiration in Pediatric Patients During General Anesthesia: Incidence and Outcome .Journal of Clinical Anesthesia 10:95–102, 1998 . https://doi.org/10.1016/S0952-8180(97)00250-X . 23-Maltby, J. R., Pytka, S., Watson, N. C., Cowan, R. A. M., & Fick, G. H. (2004). Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 51(2), 111–115. doi:10.1007/bf03018767 . 24- Pashankar, D. S., Corbin, Z., Shah, S. K., & Caprio, S. (2009). Increased Prevalence of Gastroesophageal Reflux Symptoms in Obese Children Evaluated in an Academic Medical Center. Journal of Clinical Gastroenterology, 43(5), 410–413.doi:10.1097/mcg.0b013e3181705ce9 25- Mortensen, A., Lenz, K., Abildstrøm, H., & Lauritsen, T. L. B. (2011). Anesthetizing the obese child. Pediatric Anesthesia, 21(6), 623–629. doi:10.1111/j.1460-9592.2011.03559.x 26- Anderson, B. J., & Holford, N. H. (2017). What is the best size predictor for dose in the obese child? Pediatric Anesthesia, 27(12), 1176–1184. doi:10.1111/pan.13272. 27- Reynolds, T., Sankaran, S., Chimbira, W. T., Phan, T., & Nafiu, O. O. (2018). Severe Obesity and Sleep-Disordered Breathing as Risk Factors for Emergence Agitation in Pediatric Ambulatory Surgery. Journal of PeriAnesthesia Nursing, 33(3), 304–311. doi:10.1016/j.jopan.2016.09.007. 28-NAFIU, O. O., REYNOLDS, P. I., BAMGBADE, O. A., TREMPER, K. K., WELCH, K., & KASA-VUBU, J. Z. (2007). Childhood body mass index and perioperative complications. Pediatric Anesthesia, 17(5), 426–430.doi:10.1111/j.1460-9592.2006.02140.x. 29- Juvin, P., Blarel, A., Bruno, F., & Desmonts, J.-M. (2003). Is Peripheral Line Placement More Difficult in Obese Than in Lean Patients? Anesthesia & Analgesia, 1218.doi:10.1213/01.ane.0000050570.85195.29. 30- Yen, K., Riegert, A., & Gorelick, M. H. (2008). Derivation of the DIVA Score. Pediatric Emergency Care, 24(3), 143–147.doi:10.1097/pec.0b013e3181666f32. 31- NAFIU, O. O., BURKE, C., COWAN, A., TUTUO, N., MACLEAN, S., & TREMPER, K. K. (2010). Comparing peripheral venous access between obese and normal weight children. Pediatric Anesthesia, 20(2), 172–176. doi:10.1111/j.1460-9592.2009.03198.x 32- Neilipovitz, D. T., & Crosby, E. T. (2007). No evidence for decreased incidence of aspiration after rapid sequence induction. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 54(9), 748–764.doi:10.1007/bf03026872. 33- Ross, P. A., & Scott, G. M. (2006). Childhood obesity: a growing problem for the pediatric anesthesiologist. Seminars in Anesthesia, Perioperative Medicine and Pain, 25(3), 142–148. doi:10.1053/j.sane.2006.05.007. 34- Keaney, A., Diviney, D., Harte, S., & Lyons, B. (2004). Postoperative behavioral changes following anesthesia with sevoflurane. Pediatric Anesthesia, 14(10), 866–870.doi:10.1111/j.1460-9592.2004.01310.x. 35- De Baerdemaeker, L. E., Mortier, E. P., & Struys, M. M. (2004). Pharmacokinetics in obese patients. Continuing Education in Anaesthesia Critical Care & Pain, 4(5), 152–155.doi:10.1093/bjaceaccp/mkh042. 36- Cheymol, G. (2000). Effects of Obesity on Pharmacokinetics. Clinical Pharmacokinetics, 39(3), 215–231.doi:10.2165/00003088-200039030-00004. 37- Leykin, Y., Pellis, T., Lucca, M., Lomangino, G., Marzano, B., & Gullo, A. (2004). The Pharmacodynamic Effects of Rocuronium When Dosed According to Real Body Weight or Ideal Body Weight in Morbidly Obese Patients. Anesthesia & Analgesia, 99(4), 1086–1089.doi:10.1213/01.ane.0000120081.99080.c2. 38- Ageno, W., Becattini, C., Brighton, T., Selby, R., & Kamphuisen, P. W. (2008). Cardiovascular Risk Factors and Venous Thromboembolism: A Meta-Analysis. Circulation, 117(1), 93–102.doi:10.1161/circulationaha.107.709204 39- Setzer N., Saade E. (2007). Childhood obesity and anesthetic morbidity. Pediatric Anesthesia, 17(4), 321–326.doi:10.1111/j.1460-9592.2006.02128.x. 40- Raghavan, K., Moo, D. X. Y., & Tan, Z. (2018). Severe obesity in children as an independent risk factor for perioperative respiratory adverse events during anaesthesia for minor non-airway surgery, a retrospective observational study. Proceedings of Singapore Healthcare, 28(2), 83–89.doi:10.1177/2010105818802994. 41- Cook-Sather S. D., Gallagher P. R., Kruge L. E., Beus J. M., Ciampa B. P. Welch, K. C., … Schreiner, M. S. (2009). Overweight/Obesity and Gastric Fluid Characteristics in Pediatric Day Surgery: Implications for Fasting Guidelines and Pulmonary Aspiration Risk. Anesthesia & Analgesia, 109(3), 727–736.doi:10.1213/ane.0b013e3181b085ff. 42- Smith H. L., Meldrum D. J., Brennan L. J. (2002).Childhood obesity: a challenge for the anaesthetist? Pediatric Anesthesia, 12(9), 750–761.doi:10.1046/j.1460-9592.2002.00781.x 43- Riechelmann, H., Blassnigg, E. C., Profanter, C., Greier, K., Kral, F., & Bender, B. (2014). No association between obesity and post-tonsillectomy haemorrhage. The Journal of Laryngology & Otology, 128(05), 463–467.doi:10.1017/s0022215114000863. 44- Ates, U., Ergun, E., Gollu, G., Sozduyar, S., Can, O. S., & Yagmurlu, A. (2018). Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results. Pediatrics International, 60(5), 461–466.doi:10.1111/ped.13545.

Obez Çocuklarda Anestezi

Year 2020, Volume: 4 Issue: 1, 40 - 51, 09.03.2020
https://doi.org/10.33716/bmedj.678177

Abstract

Bu derlemede çocukluk çağındaki obezitenin tanımı, epidemiyolojisi, etyolojisi, patofizyolojisi, farmakoloji ve tedavisi ile anestezi yönetimi konusundaki bilgiler literatür eşliğinde gözden geçirilecektir.
Derleme hazırlanırken bazı amaçlar hedeflendi;
1- Pediyatrik hastalarda obezitenin nadir görüldüğü, her ülkenin sadece kendisinde obezitenin olduğunu düşündüğü ve çocuk obezitesinin uzun dönemli yan etkileri olmadığına dair mitleri yok etmek.
2- “Yeni bin yılın pandemisi” olarak isimlendirilen çocukluk çağı obezitesine karşı anestezi doktorlarını literatürde nadiren değinilen bir soruna karşı duyarlılaştırmak.

Supporting Institution

yok

Project Number

yok

Thanks

Sayın Editör Makalemizin yayınlanması için gereğinin yapılmasını saygılarımla arz ederim

References

  • 1- Saka N, Akçay T.Çocuk Endokrinolojisi ve Diyabet Derneği- Çocuk endokrinolojisinde uzlaşı. Çocuk Endokrinolojisi Diyabet derneği Yayınları-V: 171-181. 2- Owen J, John R. Childhood obesity and the anaesthetist. Continuing Education in Anaesthesia, Critical Care & Pain 2012; Volume 12 Number 4: 169-175. 3- Nafiu O, Curcio C. Simplified table to identify overweight and obese children undergoing anesthesia. Pediatric Anesthesia 2013; 23: 962–970. 4- Lobstein T, Jackson-Leach R, Lmoodie M, Dhall K, Lgortmaker S, swinburn B, James P, Wang Y, McPherson K. Child and adolescent obesity: part of a bigger pictureVolume 385, Issue 9986, 20–26 June 2015, Pages 2510-2520, https://doi.org/10.1016/S0140-6736(14)61746-3 5- ÇATLI G, BÜYÜKGEBİZ A. Çocuk ve Ergenlerde Obezite: Tanım ve Epidemiyoloji Turkiye Klinikleri J Pediatr Sci. 2015;11(3):7-21 6- Jeyakumar A, Fettman N, Armbrecht ES, Mitchell R. A systematic review of adenotonsillectomy as a risk factor for childhood obesity. Otolaryngol Head Neck Surgery 2011; 144(2): 154-8. 7-Lustig RH., Post SR., Srivannaboon K., Rose SR., Danish RK., Burghen GA.,Xiong X., Wu S., Merchant TE. Risk Factors for the Development of Obesity in Children Surviving Brain Tumors. The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 2, 1 February 2003, Pages 611–616, https://doi.org/10.1210/jc.2002-021180 8- Nafiu O, Green GE., Walton SA., Morissa M., Reddy S., Tremper K. Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy. International Journal of Pediatric Otorhinolaryngology 2009 Volume 73, Issue 1: Pages 89-95, https://doi.org/10.1016/j.ijporl.2008.09.027 9- Chidambaran V., Tewari A., Mahmoud M. Anesthetic and pharmacologic considerations in perioperative care of obese children. Journal of Clinical Anesthesia Volume 45, March 2018, Pages 39-50. https://doi.org/10.1016/j.jclinane.2017.12.016. 10- Raghavan K., Moo Y., Tan Z. Severe obesity in children as an independent risk factor for perioperative respiratory adverse events during anaesthesia for minor non-airway surgery, a retrospective observational study Proceedings of Singapore Healthcare 2019 Vol 28, Issue 2.. https://doi.org/10.1177/2010105818802994 11- Ladosky W., Botelho MAM., Albuquerquejr J. Chest mechanics in morbidly obese non-hypoventilated patients. Respiratory Medicine April 2001 Volume 95, Issue 4; 281-286. 12- Lang JE., Feng H., Lima JJ.,, Harmd P. Body Mass Index-Percentile and Diagnostic Accuracy of Childhood Asthma Journal of Asthma 2009;46:291–299.DOI: 10.1080/02770900802712963 13- Verhulst SL., Aerts L, Jacobs S., Schrauwen N., Haentjens D., Claes R.,Vaerenberg H., Van Gaal LF., De Backer WA, Desager KN. Sleep-Disordered Breathing, Obesity, and Airway Inflammation in Children and Adolescents Chest 2008; 134:1169-1175 14- Li X., Li S., Ulusoy E., Chen W., Srinivasan SR., Berenson GS. Childhood Adiposity as a Predictor of Cardiac Mass in Adulthood The Bogalusa Heart Study. Circulation. 2004;110:3488-3492. DOI: 10.1161/01.CIR.0000149713.48317.27 15- Gidding SS., Nehgme R., Heise C., Muscar C., Linton A., Hassink S. SEVERE OBESITY ASSOCIATED WITH CARDIOVASCULAR DECONDITIONING, HIGH PREVALENCE OF CARDIOVASCULAR RISK FACTORS, DIABETES MELLITUS/HYPERINSULINEMIA, AND RESPIRATORY COMPROMISE. J Pediatr 2004;144:766-9 16- Martini G., Riva P., Rabbia F., Molini V., Ferrero GB., Cerutti F., Carra R.,Veglio F. Heart rate variability in childhood obesity. ClinicalAutonomic Research 2001, 11:87-91 17-Tounian P., Aggoun Y., Dubern B., Varille V., Guy-Grand B., Sidi D., Girardet JP., Bonnet D. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001; 358: 1400–04 18- Sinha A., Kling S. A Review of Adolescent Obesity: Prevalence, Etiology, and Treatment. OBES SURG (2009) 19:113–120 DOI 10.1007/s11695-008-9650-4 19- Craig, M. E., Hattersley, A., & Donaghue, K. C. (2009). Definition, epidemiology and classification of diabetes in children and adolescents. Pediatric Diabetes, 10, 3–12.doi:10.1111/j.1399-5448.2009.00568.x. 20- Association, A. D. (2000).Type 2 Diabetes in Children and Adolescents. Pediatrics, 105(3), 671–680.doi:10.1542/peds.105.3.671. 21- Vaughan RW., Bauer S., Wise L. VOLUME AND PH OF GASTRIC JUICE IN OBESE PATIENTS. ANESTHESIOLOGY; U.S.A.; DA. 1975; VOL. 43; NO 6; PP. 686-689. 22- Borland LM., Sereika SM., Woelfel SK., Saitz EW., Carrillo PA., Lupin JL., Motoyama EK. Pulmonary Aspiration in Pediatric Patients During General Anesthesia: Incidence and Outcome .Journal of Clinical Anesthesia 10:95–102, 1998 . https://doi.org/10.1016/S0952-8180(97)00250-X . 23-Maltby, J. R., Pytka, S., Watson, N. C., Cowan, R. A. M., & Fick, G. H. (2004). Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 51(2), 111–115. doi:10.1007/bf03018767 . 24- Pashankar, D. S., Corbin, Z., Shah, S. K., & Caprio, S. (2009). Increased Prevalence of Gastroesophageal Reflux Symptoms in Obese Children Evaluated in an Academic Medical Center. Journal of Clinical Gastroenterology, 43(5), 410–413.doi:10.1097/mcg.0b013e3181705ce9 25- Mortensen, A., Lenz, K., Abildstrøm, H., & Lauritsen, T. L. B. (2011). Anesthetizing the obese child. Pediatric Anesthesia, 21(6), 623–629. doi:10.1111/j.1460-9592.2011.03559.x 26- Anderson, B. J., & Holford, N. H. (2017). What is the best size predictor for dose in the obese child? Pediatric Anesthesia, 27(12), 1176–1184. doi:10.1111/pan.13272. 27- Reynolds, T., Sankaran, S., Chimbira, W. T., Phan, T., & Nafiu, O. O. (2018). Severe Obesity and Sleep-Disordered Breathing as Risk Factors for Emergence Agitation in Pediatric Ambulatory Surgery. Journal of PeriAnesthesia Nursing, 33(3), 304–311. doi:10.1016/j.jopan.2016.09.007. 28-NAFIU, O. O., REYNOLDS, P. I., BAMGBADE, O. A., TREMPER, K. K., WELCH, K., & KASA-VUBU, J. Z. (2007). Childhood body mass index and perioperative complications. Pediatric Anesthesia, 17(5), 426–430.doi:10.1111/j.1460-9592.2006.02140.x. 29- Juvin, P., Blarel, A., Bruno, F., & Desmonts, J.-M. (2003). Is Peripheral Line Placement More Difficult in Obese Than in Lean Patients? Anesthesia & Analgesia, 1218.doi:10.1213/01.ane.0000050570.85195.29. 30- Yen, K., Riegert, A., & Gorelick, M. H. (2008). Derivation of the DIVA Score. Pediatric Emergency Care, 24(3), 143–147.doi:10.1097/pec.0b013e3181666f32. 31- NAFIU, O. O., BURKE, C., COWAN, A., TUTUO, N., MACLEAN, S., & TREMPER, K. K. (2010). Comparing peripheral venous access between obese and normal weight children. Pediatric Anesthesia, 20(2), 172–176. doi:10.1111/j.1460-9592.2009.03198.x 32- Neilipovitz, D. T., & Crosby, E. T. (2007). No evidence for decreased incidence of aspiration after rapid sequence induction. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 54(9), 748–764.doi:10.1007/bf03026872. 33- Ross, P. A., & Scott, G. M. (2006). Childhood obesity: a growing problem for the pediatric anesthesiologist. Seminars in Anesthesia, Perioperative Medicine and Pain, 25(3), 142–148. doi:10.1053/j.sane.2006.05.007. 34- Keaney, A., Diviney, D., Harte, S., & Lyons, B. (2004). Postoperative behavioral changes following anesthesia with sevoflurane. Pediatric Anesthesia, 14(10), 866–870.doi:10.1111/j.1460-9592.2004.01310.x. 35- De Baerdemaeker, L. E., Mortier, E. P., & Struys, M. M. (2004). Pharmacokinetics in obese patients. Continuing Education in Anaesthesia Critical Care & Pain, 4(5), 152–155.doi:10.1093/bjaceaccp/mkh042. 36- Cheymol, G. (2000). Effects of Obesity on Pharmacokinetics. Clinical Pharmacokinetics, 39(3), 215–231.doi:10.2165/00003088-200039030-00004. 37- Leykin, Y., Pellis, T., Lucca, M., Lomangino, G., Marzano, B., & Gullo, A. (2004). The Pharmacodynamic Effects of Rocuronium When Dosed According to Real Body Weight or Ideal Body Weight in Morbidly Obese Patients. Anesthesia & Analgesia, 99(4), 1086–1089.doi:10.1213/01.ane.0000120081.99080.c2. 38- Ageno, W., Becattini, C., Brighton, T., Selby, R., & Kamphuisen, P. W. (2008). Cardiovascular Risk Factors and Venous Thromboembolism: A Meta-Analysis. Circulation, 117(1), 93–102.doi:10.1161/circulationaha.107.709204 39- Setzer N., Saade E. (2007). Childhood obesity and anesthetic morbidity. Pediatric Anesthesia, 17(4), 321–326.doi:10.1111/j.1460-9592.2006.02128.x. 40- Raghavan, K., Moo, D. X. Y., & Tan, Z. (2018). Severe obesity in children as an independent risk factor for perioperative respiratory adverse events during anaesthesia for minor non-airway surgery, a retrospective observational study. Proceedings of Singapore Healthcare, 28(2), 83–89.doi:10.1177/2010105818802994. 41- Cook-Sather S. D., Gallagher P. R., Kruge L. E., Beus J. M., Ciampa B. P. Welch, K. C., … Schreiner, M. S. (2009). Overweight/Obesity and Gastric Fluid Characteristics in Pediatric Day Surgery: Implications for Fasting Guidelines and Pulmonary Aspiration Risk. Anesthesia & Analgesia, 109(3), 727–736.doi:10.1213/ane.0b013e3181b085ff. 42- Smith H. L., Meldrum D. J., Brennan L. J. (2002).Childhood obesity: a challenge for the anaesthetist? Pediatric Anesthesia, 12(9), 750–761.doi:10.1046/j.1460-9592.2002.00781.x 43- Riechelmann, H., Blassnigg, E. C., Profanter, C., Greier, K., Kral, F., & Bender, B. (2014). No association between obesity and post-tonsillectomy haemorrhage. The Journal of Laryngology & Otology, 128(05), 463–467.doi:10.1017/s0022215114000863. 44- Ates, U., Ergun, E., Gollu, G., Sozduyar, S., Can, O. S., & Yagmurlu, A. (2018). Pediatric laparoscopic sleeve gastrectomy in Turkey: Short-term results. Pediatrics International, 60(5), 461–466.doi:10.1111/ped.13545.
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Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section REVIEW
Authors

Ezgi Erkılıç 0000-0002-1211-9354

Project Number yok
Publication Date March 9, 2020
Published in Issue Year 2020 Volume: 4 Issue: 1

Cite

APA Erkılıç, E. (2020). Obez Çocuklarda Anestezi. Balıkesir Medical Journal, 4(1), 40-51. https://doi.org/10.33716/bmedj.678177