Recent advances in anesthesia of the obese patient

Brodsky, Jay B.

doi:10.12688/f1000research.15093.1

Cited by 18 publications

(17 citation statements)

References 14 publications

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“…Obesity increases the risk of difficult mask ventilation, but its association with difficult intubation remains controversial [29]. The fourth UK National Audit Project (NAP4) reported an increased risk of adverse airway events in obese patients, often contributed to by lack of recognition and planning for a potentially difficult airway, exacerbated by rapid desaturation and increased difficulty with rescue techniques [30].…”

Section: Peri‐operative Management Of Women Who Are Obesementioning

confidence: 99%

Obesity in women: anaesthetic implications for peri‐operative and peripartum management

Tan

Habib

2021

Anaesthesia

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Summary The prevalence, healthcare and socio‐economic impact of obesity (defined as having a body mass index of ≥ 30 kg.m‐2) are disproportionately higher in women than men. A combination of biological and social factors, including the adaptation of energy homeostasis to the increased demands of pregnancy and lactation and poor access to healthy foods or exercise facilities, contribute to the increasing prevalence of obesity in women. Obesity‐related physiological changes stem from mass loading and increased metabolism of adipose tissue, as well as secretion of bioactive substances from adipocytes leading to chronic low‐grade inflammation. As a result, obesity is associated with increased risks of: infertility; malignancy; sleep‐disordered breathing; cardiovascular disease; diabetes; and thromboembolism. Hence, obese women are at markedly increased risk of peri‐operative morbidity and mortality and require comprehensive evaluation and targeted comorbidity optimisation by a multidisciplinary team. In addition to routine obstetric challenges, pregnancy in women with obesity further exacerbates the above risks, making multidisciplinary management starting at pre‐conception even more important. Weight loss, lifestyle management and optimisation of comorbidity are the cornerstone of reducing obesity‐related risks. The anaesthetist plays a vital role within the multidisciplinary team by emphasising weight loss as part of pre‐operative comorbidity optimisation, formulation of individualised peri‐operative management plans, supervising postoperative care in the high dependency or intensive care settings and providing safe labour analgesia and careful peripartum management for obese parturients.

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Section: Peri‐operative Management Of Women Who Are Obesementioning

confidence: 99%

Obesity in women: anaesthetic implications for peri‐operative and peripartum management

Tan

Habib

2021

Anaesthesia

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“…Resultant anaesthetic challenges include accurately measuring patients' blood pressure, obtaining intravenous access, achieving regional techniques and the potential for difficult airway management and ventilation. 9 In addition to anaesthetic and mobilisation issues, coexistent cardiac, respiratory and metabolic complications add to the perioperative challenges presented. An individualised riskbenefit analysis should be undertaken and nonoperative alternatives encouraged.…”

Section: Behavioural Modificationmentioning

confidence: 99%

“…As obesity becomes more prevalent, greater numbers of increasingly obese women will undergo gynaecological laparoscopy. Resultant anaesthetic challenges include accurately measuring patients’ blood pressure, obtaining intravenous access, achieving regional techniques and the potential for difficult airway management and ventilation 9 . In addition to anaesthetic and mobilisation issues, coexistent cardiac, respiratory and metabolic complications add to the perioperative challenges presented.…”

Section: Outpatient Preoperative Managementmentioning

confidence: 99%

Life in the laparoscopic fast lane: evidence‐based perioperative management and enhanced recovery in benign gynaecological laparoscopy

Bryant‐Smith¹,

As‐Sanie

Lloyd

et al. 2021

The Obstetric & Gynaecologis

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Enhanced recovery after surgery (ERAS) protocols aim to shorten the length of hospital stay and expedite recovery, without increasing complications or readmission rates. Implementation of ERAS protocols should be evidence-based, including when applied to pre-admission clinic (including preoperative investigations), fasting, antibiotic prophylaxis, thromboprophylaxis, analgesia, expeditious removal of urinary catheters and early mobilisation. Learning objectivesTo understand evidence-based perioperative management of patients undergoing laparoscopic procedures for benign gynaecological indications. To appraise critically the judicious ordering of preoperative investigations.To understand the importance of preoperatively assessing and managing each patient's risk of venous thromboembolism. To understand the key components of perioperative management that decrease surgical site infection(s). Ethical issuesPreoperative patient education is a vital component of perioperative management; written materials should be prepared in languages other than English to enable all patients to benefit from the ERAS approach. A balance must be found between applying ERAS protocols as a checklist to ensure all aspects of patient care have been considered and tailoring those protocols to each patient's individual needs.

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“…Overweight patients may be at an increased risk for anesthesia‐related complications related to airway management and medication dosing . In addition, morbidly obese patients with a body mass index greater than 40 kg/m may experience complications (eg, superficial SSI, prosthetic implant infection) more frequently than nonobese patients …”

Section: Preoperative Phase Of Carementioning

confidence: 99%

Perioperative Nursing Considerations for Patients Undergoing Total Hip or Knee Arthroplasty

Tripp¹,

Fencl²

2020

AORN Journal

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Recent advances in anesthesia of the obese patient

Cited by 18 publications

References 14 publications

Obesity in women: anaesthetic implications for peri‐operative and peripartum management

Obesity in women: anaesthetic implications for peri‐operative and peripartum management

Life in the laparoscopic fast lane: evidence‐based perioperative management and enhanced recovery in benign gynaecological laparoscopy

Perioperative Nursing Considerations for Patients Undergoing Total Hip or Knee Arthroplasty

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