- Guideline - Obesity in the peri-operative period
Link:www.aagbi.org/sites/default/files/Obesity07.pdf
- Key recommendations
- All anaesthetists should be confident in the management of obese patients
- All patients should have their BMI measured and recorded where possible
- Hospital should have named consultant in charge of equipment and processes
- Protocols in place and accessible where obese patients are treated
- Manual handling courses should include management of obese patients
- Pre-op assessment is a key component
- The BMI is not used as the sole indicator for location or suitability for surgery
- Pre-op assessment
- Should be assessed in multi-disciplinary clinic with cardiology, respiratory and anaesthetic input
- Respiratory
- Assess airway
- Low FRC
- Pulse oximetry
- OSAS and consider CPAP
- Wheeze may be due to airway closure and not asthma
- Cardiac
- Commoner: HT, Hyperlipidaemia, IHD, CCF
- Consider stress test
- BP may be difficult to measure
- Metabolic
- Screen for diabetes
- Look for complications of diabetes
- Poor nutritional status is common
- Consider weight loss
- TED
- Mechanical and pharmacological prophylaxis
- Intra-op
- Airway
- Previous charts
- Reflux risk assessed
- History of OSAS
- Adequate manpower if need to move patient
- Prepare for difficult airway
- Consider ramping the patient for pre-O₂ and intubation
- Consider AFOI
- Regional
- Ensure experienced anaesthetist does procedure
- Prepare for failure, have long needles present
- Consider SAB
- Day surgery
- BMI under 40 can be suitable
- BMI over 40 may be suitable but should be reviewed by anaesthetist with interest in day case surgery
- Defined as BMI >30
Morbidly obese >40 or >35 in the presence of obesity related co-morbidity