Riskfaktorer och strategier för ökad patientsäkerhet i samband med extubering av personer med obesitas efter generell anestesi– En systematisk litteraturöversikt

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Sammanfattning: Background: The number of people with obesity is increasing in society and thus also the requirements for the anaesthetist nurse to be able to give this group good and safe anaesthetic care since obesity is linked with increased ventilation-associated risks with general anaesthesia. Extubation can be a risky moment and the anaesthetist nurse can perform it independently or along with the anaesthesiologist at the end of the anesthesia. Aim: To describe the risk factors and strategies to prevent ventilation-associated complications in connection with extubation with patients who have BMI over 30 that is undergoing anaesthesia. Method: A quantitative systematic literature study based on seven scientific articles. The articles were searched using database PubMed, Cinahl and Scopus and were quality examined. The studies were searched systematically, compiled and analyzed.Results: The result is based on two categories. One of these are risk factors related to obesity and ventilation. This contains the importance of correct reversal, use and monitoring of muscle relaxants. It also highlighted a decreased use of oxygen concentration intraoperatively and before extubation for improved oxygenation postoperatively. The second category charted strategies to reduce risks ventilation associated side effects connection with extubation. Non-invasive ventilation with CPAP or Bi-level treatment can improve lung volume and oxygenation if used immediately after extubation. Conclusion: Extubation is a critical moment during general anesthesia, particularly in people with BMI> 30. Safe extubation of obese requires to be a step ahead and careful planning. There is a correlation between risk factors in connection with obesity and ventilation complications. Strategies like NIV used directly after extubation are beneficial to people with obesity. Using lower oxygen concentrations intraoperatively, at the end of anesthesia and proper use of muscle relaxants, refines extubation.

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