Tuesday, 18 August 2015

Peri-operative management of the obese surgical patient 2015. AAGBI, Society for Obesity & Bariatric Anaesthesia. Anaesthesia June 2015.

This consensus statement was developed because of the increased recognition that obese patients present a different set of challenges and require specific peri-operative care. This guideline serves as a good revision all of us and is also particularly useful for those sitting part 1 & part 2 exams.

In summary there are 16 points of recommendation:

  1. Every hospital should nominate an anaesthetic lead for obesity.
  2. Operating lists should include the patients’ weight and body mass index (BMI).
  3. Experienced anaesthetic and surgical staff should manage obese patients.
  4. Additional specialised equipment is necessary.
  5. Central obesity and metabolic syndrome should be identified as risk factors.
  6. Sleep-disordered breathing and its consequences should always be considered in the obese.
  7. Anaesthetising the patient in the operating theatre should be considered.
  8. Regional anaesthesia is recommended as desirable but is often technically difficult and may be impossible to achieve.
  9. A robust airway strategy must be planned and discussed, as desaturation occurs quickly in the obese patient and airway management can be difficult.
  10. Use of the ramped or sitting position is recommended as an aid to induction and recovery.
  11. Drug dosing should generally be based upon lean body weight and titrated to effect, rather than dosed to total body weight.
  12. Caution is required with the use of long-acting opioids and sedatives.
  13. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used.
  14. Depth of anaesthesia monitoring should be considered, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs.
  15. Appropriate prophylaxis against venous thromboembolism (VTE) and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese.
  16. Postoperative intensive care support should be considered, but is determined more by co-morbidities and surgery than by obesity per se.

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