Obesity: its relation to anaesthesia

Abstract

'He's fat, and scant of breath'Hamlet, Act V, Sc. I1 In spite of the aesthetic appeal and physical advantages of slimness, obesity remains the commonest nutritional disorder in civilised countries today. Although the Registrar General's statistical review of England and Wales, for 1971, listed obesity as the cause of death in only 170 patients,' the risks imposed on health and life by this disorder are not readily measured. The gross dangers, revealed by the Society of Actuaries' data, show that people who are 20% overweight increase their chances of dying from heart disease by 40% and from cerebro-vascular disease by 50%.' It has been suggested that being 10 Ib (4.5 kg) overweight carries a greater risk to health than smoking 25 cigarettes a day.3 Yet, in spite of an increasing indictment against obesity, the full implications of its adverse physiological effects are still incompletely investigated ; not least of all the response of obese people to anaesthesia and surgery.Obesity means excessive adiposity being derived from the Latin 'obesus' meaning 'fattened by eating'. The implication of the word 'obesity' itself is that 'the flesh has

Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital

“…Many studies suggest techniques to improve accuracy in the preoperative prediction of intubation difficulty. 2,[7][8][9][10][11][12] However, the success of these strategies is limited and unexpected difficult airways continue to be a leading cause of morbidity, mortality, and litiga- tion in anesthetic practice. 6,14,15 Previous studies report a narrow range of failure to intubate by direct laryngoscopy of between 0.04 and 0.3%.…”

“…The large number of studies which have attempted to quantify the incidence of difficult intubation and/or describe associated risk factors demonstrates this fact. [1][2][3][4][5][6][7][8][9][10][11][12] Despite the importance of this subject, there is no uniform definition of the difficult airway. 13 Previous definitions include number of laryngoscopy attempts, duration of laryngoscopy attempts, and laryngoscopic view.…”

Multidisciplinary treatment of obesity with a protein-sparing modified fast: results in 668 outpatients.

“…Moreover, patients who undergo major elective surgical procedures during the time their weight is reduced could have lower risk of complications. [47][48][49] Weight loss followed by rapid regain, on the other hand, may be harmful. We have observed, along with others, that patients seem to have a more difficult time on VLCD programs which follow previous weight loss and regain [Kelly Brownell, PhD, personal communication].…”

The lateral recumbent head-down position decreases the incidence of epidural venous puncture during catheter insertion in obese parturients

“…[8][9][10] There is a consensus that, if at all possible, general anesthesia should be avoided in the obese pregnant patient, with due attention being paid to technical difficulties in placing the epidural catheter in the presence of morbid obesity. A sensible recommendation has been the insertion of an epidural catheter early in labour in an obese parturient, thus allowing the anesthesiologist to establish good analgesia in a calm, controlled atmosphere, rather than hurrying in the event of an emergency situation.…”