Anesthesia management of a morbidly obese patient in prone position for lumbar spine surgery

Baxi, Vaibhavi; Budhakar, Shashank

doi:10.4103/0974-8237.65483

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…[ 14 ] In a single case study, 3 major anesthetic risk factors for a 45-year-old female with morbid obesity (e.g., a body mass index of 47 kg/m 2 ) undergoing acute lumbar discectomy/fusion for a cauda equina syndrome included morbid obesity, the prone position, and airway complications. [ 4 ]…”

Section: Anesthetic Risks With Morbid Obesitymentioning

confidence: 99%

More risks and complications for elective spine surgery in morbidly obese patients

Epstein¹

2017

Surg Neurol Int

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Background:The vast majority of studies emphasize the greater morbidity/mortality for elective spine surgery in morbidly obese patients.Methods:This review focuses on the increased morbidity/mortality of performing elective spinal operations in morbidly obese patients. There are two definitions of morbid obesity; a body mass index (BMI) of equal to or greater than 35 plus two major comorbid factors (e.g., hypertension, diabetes, etc.) or a BMI (morbidly obese III) of =≥40 kg/m2.Results:For patients undergoing spinal surgery, morbid obesity increases perioperative morbidity/mortality for various reasons. The quality of preoperative and intraoperative imaging is often compromised potentially leading to mistaken preoperative diagnoses, and wrong level surgery. Resultant major technical surgical limitations include poor/inadequate operative exposure, and the risk of suboptimal placement of instrumentation There is also increased exposure to major perioperative complications such as deep venous thrombosis, pulmonary embolism, infection, pneumonia, cardiac complications, blindness in the prone position, brachial and lumbar plexus injuries, increased anesthetic risks (e.g., even using awake intubation/awake positioning), and postoperative wound seromas/hematomas.Conclusions:Most of the spinal literature documents the marked increased perioperative morbidity/mortality for morbidly obese patients undergoing elective spine surgery. If elective surgery is warranted in these patients, the risks and timing of surgical intervention should include consideration of major preoperative weight loss strategies including bariatric procedures to optimize outcomes.

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Section: Anesthetic Risks With Morbid Obesitymentioning

confidence: 99%

More risks and complications for elective spine surgery in morbidly obese patients

Epstein¹

2017

Surg Neurol Int

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“…Major concerns of spine surgery in the prone position include the risk of airway loss due to the kinking of the endotracheal tube, obstruction due to mucous plug or blood clot, and accidental extubation [6]; difficulty in positioning, and severe cardiopulmonary compromise. If the abdomen is not maintained free, there is a worsening of prevailing epidural venous engorgement due to obesity, enhancing blood loss in spine surgeries.…”

Section: Discussionmentioning

confidence: 99%

Prone spine surgery in a morbidly obese patient: Anesthesia challenges and management

Latkar¹,

Kaushik²,

Prabhudesai³

et al. 2022

Indian J Case Reports

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India is seeing a rapid epidemiological transition from underweight to overweight, with an overall prevalence of obesity reported to be 40.3%. Anesthesiology concerns in an obese patient are well known. We elaborate on the anesthesia management in a 68-year-old male patient with a body mass index of 66.3 kg/m2 who underwent spine surgery in prone position. Challenges faced ranged from the size of the table to the difficult airway, difficulty in positioning, maintenance of airway and ventilation, maintaining a free abdomen, and anesthesia management with meticulous use of anesthetic drugs for an uneventful recovery.

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“…Positioning the patient once the anaesthetic has been administered is made significantly more difficult when the patient is obese 7 . Another factor is the difficulty surrounding delivery of anaesthetic care to obese patients, with a larger neck circumference being associated with greater risk of problematic intubation 22 …”

Section: Discussionmentioning

confidence: 99%

“…7 Another factor is the difficulty surrounding delivery of anaesthetic care to obese patients, with a larger neck circumference being associated with greater risk of problematic intubation. 22 Future research in this area would be improved with a prospective study ensuring accurate BMI data collection and along with the overall analysis, separate acute and elective admission analyses could be performed. Investigation into malnutrition and diet of patients would strengthen theories around underweight patients and increased cost.…”

Section: Obese Type II 61mentioning

confidence: 99%

Impact of body mass index on total cost of trauma and elective spine surgical procedures at a quaternary spinal referral centre

Eason

Vandal

Patel

2022

ANZ Journal of Surgery

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Background: Evidence surrounding obesity concludes it places a significant burden on the healthcare sector. Our objective was to quantify the financial impacts of obesity, specifically the relationship between body mass index (BMI) and total cost of spinal surgery. The links between BMI and length of stay, readmission and theatre times were explored. It was predicted that with increasing obesity, total cost would increase. Methods: Retrospective review of patients that received spinal surgery at Middlemore Hospital between 1 October 2017 and 30 November 2019. Data were collected on patient demographics, procedure details, total cost, as well as potential variables (trauma, acute/elective, surgical complexity, readmissions, comorbidities, injury severity). Data were fitted using linear and generalized linear models, with BMI fitted using natural splines. Results: Obesity prevalence in South Auckland was reflected in the study population of 533, with the average BMI being 30.16. Results for BMI less than or equal to 24, and above 48, were statistically significant (P = 0.037, 95% CI). Total cost increased on either side of BMI 33.1. BMI 18 had 60% increase in total cost (95% CI (17, 118)) and BMI 55 of 38.3% (95% CI (À8.3, 109)). Positive associations were found with increasing BMI and induction time and readmission rate respectively. The relationship between BMI and length of stay and other variables were not significant. Conclusion:The relationship between BMI and total cost is non-linear and there is an increase in induction time with higher BMI patients.

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Anesthesia management of a morbidly obese patient in prone position for lumbar spine surgery

Cited by 9 publications

References 7 publications

More risks and complications for elective spine surgery in morbidly obese patients

More risks and complications for elective spine surgery in morbidly obese patients

Prone spine surgery in a morbidly obese patient: Anesthesia challenges and management

Impact of body mass index on total cost of trauma and elective spine surgical procedures at a quaternary spinal referral centre

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