Anaesthesia for the obese patient

Wynn-Hebden, A; Bouch, D C

doi:10.1016/j.bjae.2020.07.003

Cited by 25 publications

(17 citation statements)

References 17 publications

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“…The second most common minor airway event was difficulty maintaining adequate ventilation using a SAD, present in 1.5% (n = 11/755) of non‐obese patients compared with 4.1% (n = 12/294) of obese patients (RR 2.76 [1.23–6.19]). This would support existing recommendations from NAP4 [4] and the Society of Bariatric Anaesthesia [13] to only use SADs in “ highly selected patients ”, although this patient group is not explicitly defined. These guidelines also advocate against using first‐generation SADs, especially in those patients with obesity.…”

Section: Discussionsupporting

confidence: 55%

“…). This would support existing recommendations from NAP4 [4] and the Society of Bariatric Anaesthesia [13] to only use SADs in "highly selected patients", although this patient group is not explicitly defined. These guidelines also advocate against using firstgeneration SADs, especially in those patients with obesity.…”

Section: Discussionsupporting

confidence: 54%

“…Obesity affects multiple organ systems relevant to the peri-operative period. Patients with obesity are more likely to suffer from metabolic and cardiovascular disease, have poorer physiological reserve, have significantly altered lung mechanics and airway management that is more challenging [4]. The 4 th National Audit Project of the Royal College of Anaesthetists (NAP4) found that, in major airway events, obesity was over-represented two-fold and class 3 obesity over-represented four-fold compared with the population proportion [5].…”

Section: Introductionmentioning

confidence: 99%

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Airway events in obese vs. non‐obese elective surgical patients: a cross‐sectional observational study

Shaw

Waiting²,

Barraclough³

et al. 2021

Anaesthesia

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Obesity is an increasingly prevalent comorbidity within the UK population. The aim of this study was to determine the proportion of obese patients in an elective surgical population. The second aim was to determine the choice of airway equipment and incidence of airway events in obese vs. non-obese patients. We conducted a cross-sectional observational study over two 24-h periods in March 2018 across 39 hospitals in the greater London area. Data were collected regarding 1874 patients. The incidence of obesity was 32% in the study population compared with 26% in the general UK population (p < 0.0001). Minor airway events were defined as: desaturation to S p O 2 < 90%; failed mask ventilation; supraglottic airway device problem; aspiration; airway trauma and difficult intubation; or recognised oesophageal intubation. Major airway events were defined as: unrecognised oesophageal intubation; a 'cannot intubate cannot oxygenate' emergency; the need for unplanned front-of-neck airway; cardiac arrest; or unplanned intensive care unit admission due to an airway event. In total, 89 minor and two major airway events were recorded. Obese patients were more likely to experience a minor airway event (RR 2.39, 95%CI 1.60-3.57), the most common being desaturation (S p O 2 < 90%). The use of a supraglottic airway device in obese vs. non-obese patients was associated with increased airway events ). Tracheal intubation vs. supraglottic airway device use increased with obesity class but was not associated with a decrease in airway events ). Our data suggest that obesity is more common in the elective surgical vs. general population and minor airway events are more common in obese vs. non-obese elective patients.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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Airway events in obese vs. non‐obese elective surgical patients: a cross‐sectional observational study

Shaw

Waiting²,

Barraclough³

et al. 2021

Anaesthesia

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“…On the day of the surgery, the patient should be anaesthetised by an anaesthetist with experience in bariatric anaesthesia. Anaesthesia should be induced in the head-up ramped position [ 26 ]. If possible, the patient should be anaesthetised in-theatre to avoid unnecessary transferring.…”

Section: Discussionmentioning

confidence: 99%

Colorectal Cancer and the Obese Patient: A Call for Guidelines

Petrou

Rafique

Tekkis

et al. 2022

Cancers

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The link between obesity and colorectal cancer has been well established. The worldwide rise in obesity rates in the past 40 years means that we are dealing with increasing numbers of obese patients with colorectal cancer. We aimed to review the existing guidelines and make recommendations specific to this group of patients. Upon comparing the current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®), the guidelines from the European Society of Medical Oncology (ESMO) and the guidelines of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we observed that these did not take into consideration the needs of obese patients. We proceeded to make specific recommendations with regards to the diagnostic work-up, surgical pathways, minimally invasive technique, perioperative treatment, post-operative surveillance, and management of metastatic disease in this group of patients. Our review highlights the need for modification of the existing guidelines to account for the needs of this patient cohort. A multidisciplinary approach, including principles used by bariatric surgeons, should be the way forward to reach consensus in the management of this group of patients.

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“…Ventilator-assisted modes include continuous positive airway pressure (CPAP), bilevel positive airway pressure (bi-PAP), and pressure support ventilation (PSV). 12 Application of CPAP or HFNC is recommended in obese patients to prolong safe apnea time. 9 Despite these recommendations, the efficacy of HFNC in preventing desaturation and prolonging safe apnea time in obese patients has not yet been definitively demonstrated.…”

mentioning

confidence: 99%

High-Flow Nasal Cannula for Apneic Oxygenation in Obese Patients for Elective Surgery: A Systematic Review and Meta-Analysis

Bright

Harley

Velli

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Obese patients desaturate rapidly during the apneic period after induction of anesthesia for elective surgery. Administration of oxygen using high-flow nasal cannulae (HFNCs) may prevent desaturation in nonobese patients compared to facemask (FM) preoxygenation. The aim of this meta-analysis was to compare the effectiveness of HFNC to FM preoxygenation techniques in reducing preintubation desaturation in obese patients undergoing elective surgery. METHODS: This study protocol was registered on PROSPERO (CRD42022309391). Adult studies that compared HFNC and FM preoxygenation in obese patients requiring general anesthesia for elective surgery were included. The primary outcome was desaturation resulting in oxygen saturation of <92% from induction of anesthesia until intubation. Secondary outcomes included the lowest arterial oxygen content before intubation expressed in mm Hg, safe apnea time expressed in seconds, the lowest oxygen saturation before intubation expressed as a percentage, patient-reported discomfort, the need for rescue ventilation, and the incidence of aspiration of gastric contents during intubation. Risk of bias was assessed using the Cochrane Collaboration tool. Certainty was assessed following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Six studies including 351 participants were eligible for analysis. There was no difference in odds of oxygen desaturation <92% between HFNC and FM (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.15-1.63; P = .24). The HFNC group had a significantly longer safe apnea time (mean difference [MD], -124.20 with 95% CI, -200.47 to −47.93; P = .001). There was no difference between HFNC and FM in the lowest arterial oxygen content (MD, −23.90; 95% CI, −88.64 to 40.85; P = .47) and the lowest peripheral oxygenation saturation (MD, −0.47 with 95% CI, -5.07 to 4.12; P = .84). HFNC had a lower odd of discomfort than FM (OR, 0.13; 95% CI, 0.03-0.52; P = .004). There was no difference in the odds of aspiration of gastric contents between HFNC and FM (OR, 0.33; 95% CI, 0.01-8.21; P = .50). The risk of bias for our primary and secondary outcomes was low. The GRADE assessment for our primary outcome indicated a low level of certainty. For secondary outcomes, the GRADE assessment indicated a very low certainty for all outcomes except for patient discomfort, which was indicated as a moderate level of certainty. CONCLUSIONS: There may be no difference between HFNC and FM preoxygenation in preventing oxygen desaturation <92% or the lowest oxygen saturation before intubation. Preparation remains important to prevent and manage desaturation during induction of obese patients.

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Anaesthesia for the obese patient

Cited by 25 publications

References 17 publications

Airway events in obese vs. non‐obese elective surgical patients: a cross‐sectional observational study

Airway events in obese vs. non‐obese elective surgical patients: a cross‐sectional observational study

Colorectal Cancer and the Obese Patient: A Call for Guidelines

High-Flow Nasal Cannula for Apneic Oxygenation in Obese Patients for Elective Surgery: A Systematic Review and Meta-Analysis

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