ABSTRACT
Introduction and Purpose: The problem of obesity has started to increase in children and adolescents, similar to adults, due to irregular and unhealthy diet, the limitation of physical activity and genetic factors. Various difficulties and complications may be encountered in the anesthesia management of obese patients. Difficult airway, difficulty in intravenous and intra-arterial intervention, difficulty in positioning the patient, difficulty in finding suitable equipment for the patient, intraoperative and postoperative pulmonary complications, prolonged recovery and difficulty in patient transport are the points to be considered in perioperative management. In our presentation, we wanted to discuss perioperative anesthesia management in adolescent bariatric surgery, which is not performed frequently, with a case study. Case Presentation: A 16-year-old girl with BMI of 44.4 was evaluated for bariatric surgery due to obesity. She had a history of hypertension, sleep apnea and insulin resistance. In her physical examination, her mouth opening was normal, her Mallampati score was 3, and her neck circumference was 43 cm. After the preoperative difficult intubation preparations were completed, the patient was monitored. The patient was preoxygenated with 100% oxygen for 3 minutes. The patient with comfortable mask ventilation was intubated with an appropriately sized endotracheal tube. Hemodynamics and oxygen saturation remained stable throughout the surgery. At the end of the surgery, she was extubated without any problem and transferred to the pediatric surgical intensive care unit. The patient was taken to the ward on the 2nd postoperative day and discharged on the 6th day. Discussion and Conclusion: The problem of obesity in adolescents is increasing today, and it is possible to struggle with obesity by making lifestyle changes, teaching children and parents about healthy nutrition, encouraging more physical activity and creating weight control programs. At this point, metabolic and bariatric surgery emerges as a preferred method in overweight, obese adolescents. The anesthesia risks of these surgeries are significantly higher. Postoperative pain management and respiratory physiotherapy should be performed in obese patients. Although prevention of obesity is the mainstay of obesity treatment, bariatric surgery is also a safe and effective treatment method in adolescents.