Safety is in the details
Safety in the ICU

The Complications of Obesity and Anesthesia

August 16, 2017

 

The rise in obesity rates is a major concern for healthcare providers. In addition to seeing more and more patients suffer from obesity-related conditions, it is also more complex to provide healthcare to these individuals.


The following CDC statistics illustrate how this problem is growing:

  • More than one-third (36.5%) of US adults have obesity
  • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death
  • The estimated annual medical cost of obesity in the U.S. was $147 billion U.S. dollars in 2008 (Incenta health published a figure of $190.2 billion in 2015); the medical costs for people who are obese were $1,429 higher than those of normal weight, (according to Incenta Health this is 36% higher)

 

Nurses and doctors are making adjustments to procedures to accommodate obese individuals, but it is increasingly clear that the standard tools and techniques might not be enough. In anesthesia there are specific challenges when the patient due to undergo surgery is obese.


The Known Risks of Administering Anesthesia to Obese Patients


Being overweight, and especially obese, puts an individual at a higher risk when undergoing surgery – with one of the primary concerns being the administration of anesthesia.


The known risks include:

  • Difficulty in locating veins for intravenous medication
  • Determining a proper medication dose relative to body size
  • Ensuring proper oxygen and airflow before, during, and after surgery
  • Taking more time to regain consciousness
  • Intubation

 


Anesthesia Options for Obese Patients


During the preoperative assessment, health practitioners will create a tailored plan for each patient regarding anesthetic management. At this point, it may be determined that additional measures are required to safely and effectively administer anesthesia to the patient.


The preoperative assessment includes:

  • Airway assessment
  • Mallampati score
  • Thyromental distance (TMD)
  • Respiratory and oxygenation status
  • Snoring, tiredness, observed apnea, and high blood pressure with BMI, age, and neck circumference (STOP-BANG)
  • Cardiovascular system assessments
  • Patient transportation planning

 

The chances of multiple measures being determined upon is higher when the patient is obese.


Multimodal Approach


It is recommended to take a multimodal approach to improving patient outcome, and perioperative epidural anesthesia (EDA) is often essential to prevent from relying exclusively on opioid administration for anesthesia. While the subject is still up for debate, one recent study found that EDA improved postoperative vital capacity, lung volumes, and other spirometric values quicker than patients who were treated with opioids.


Due to the lack of palpable bony landmarks and the depth of space in the fatty tissue of an obese patient, a multimodal analgesic approach is often more practical. This might include the use of opioids, acetaminophen, NSAIDs, and local anesthetic.


Postoperative Considerations for Obese Patients


Unless the patient has any ongoing medical conditions other than obesity, or underwent major surgery, they are usually nursed on the surgical floors following a complication-free surgery. However, extra precautions might still be necessary. For example, obese individuals who use a CPAP machine at home will benefit from a postoperative CPAP.


Maintaining safe IV connections can be a challenge in obese patients. Also, these patients may require more intravenous medication because intramuscular injections often are not a viable option in morbidly obese individuals.


This is where the Marvelous Stopcock and Safe2 Rotator acan ve useful. They can prevent disconnections and ensure medication is properly flushed – plus they keep nurses safer by preventing needle sticks.
 

Learn more about Marvelous Stopcock.


Source:
https://www.cdc.gov/obesity/data/adult.html
https://www.asahq.org/whensecondscount/patients%20home/preparing%20for%20surgery/surgery%20risks/obesity%20and%20anesthesia
http://ceaccp.oxfordjournals.org/content/8/5/151.full

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