Anesthesia in Obese Patients in Lubumbashi: Spirometric Specificities and Perioperative Complications

Introduction: Obesity is defined as an excessive increase in fat mass, leading to somatic, psychological, and social repercussions, as well as an impact on individuals’ quality of life. In anesthesia, obese patients are at risk of complications, particularly respiratory issues, in resource-limited environments where respiratory function testing is scarce. Aim: This work aims to contribute to the understanding of spirometric abnormalities and perioperative complications in our environment. Background: Obesity is associated with numerous comorbidities and is notably a major risk factor for sleep apnea syndrome (SAS), with 30% to 70% of obese patients being apneic. Moreover, increased intra-abdominal pressure leads to changes in respiratory mechanics and a significant reduction in lung volumes, particularly functional residual capacity (FRC), which predisposes obese patients to atelectasis formation. As a result, obese patients are at increased risk of respiratory complications, including acute respiratory distress syndrome (ARDS). Any surgical procedure in the obese population carries a high risk, and perioperative respiratory complications remain common in these patients. Airway management is also particularly challenging. Methods: This is a cross-sectional analytical study conducted over 12 months in the anesthesia and intensive care department of the University Clinics of Lubumbashi and Medpark Clinic of Lubumbashi/DR Congo. Results: Forty-seven obese patients were included out of 1394 operated subjects, representing a frequency of 3.37%. The mean age is 39.13 years ± 10.48 years (range 19 - 65 years), with women accounting for 78.7% of the study population. The mean BMI of obese patients was 37.06 kg/m² ± 6.16 kg/m². Most patients were classified as ASA 2 (51.1%) and operated under spinal anesthesia (56.6%), with obstetric surgery being the most frequent (31.9%). Five obese patients exhibited obstructive respiratory disorders (10.6%), 23 had restrictive disorders (48.9%), and three others (6.4%) presented mixed disorders. Desaturation was the respiratory complication observed in 2.1% of cases during surgery and 4.3% postoperatively. Conclusion: Obese patients present undiagnosed respiratory abnormalities due to a lack of respiratory function assessment in our environment. Standardizing their perioperative anesthetic management could help reduce morbidity and mortality.