A discussion of airway and respiratory complications along with general considerations in obese patients

Abstract

Obesity is defined as the degree of excess weight associated with adverse health consequences. Within Great Britain, it is reported that a quarter of men and women are obese; these rates have trebled over the past 20 years. In 2001, it was estimated that obesity cost the National Health Service at least half a billion pounds, with a further two billion pounds lost on lower productivity and lost output. Obesity poses a significant risk factor for diseases, such as coronary heart disease, diabetes mellitus and certain forms of cancer, amongst others. Obese individuals pose significant problems to the clinician because of airway and respiratory complications. Sleep apnoea, obesity-hypoventilation syndrome, pulmonary atelectasis are associated with obesity and tracheostomy insertion is made all the more difficult in these patients. This article aims to discuss some of these issues relevant to the clinician and examine present strategies for dealing with them.

A Review of the Toxicologic Implications of Obesity

“…For this reason, such agents should be avoided by patients with sleep apnea. Obese patients may also suffer from obesity hypoventilation syndrome, which results in daytime hypoxemia and a blunted respiratory response to acidemia [30]. There are conflicting reports on the mechanism of these effects that often fail to differentiate between central and anatomic contributions.…”

In vitroproton magnetic resonance spectroscopy of liver tissue informsin vivohepatic proton magnetic resonance spectroscopy studies

“…It is not surprising that patients with cancer ± radiotherapy, pediatric patients, and obese patients are heavily represented. Each of these cases presents specific challenges and risks that have previously been described 18, 19. Other associated factors reported (e.g., coagulopathy, neck trauma, burn injuries) are also intuitively plausible as risk factors for complications.…”

Analysis of morbidity, mortality, and risk factors of tracheostomy-related complications in patients with oral and maxillofacial cancer

“…BMI is related to obesity. In obese patients, there are many concerns regarding the technical difficulties of performing tracheostomy owing to the potential anatomic variations: palpation of the anterior neck landmarks [13], excessive submental and upper thoracic tissue obstruction of the surgical field, extension of the neck, thickness of tissues overlying the trachea, posteroanterior slant of the trachea owing to excess adipose tissue between the sternum and trachea, displacement of the airway structures inferiorly into the chest because of a short neck [14], and limitations for the placement of a standard tracheostomy tube curvature in relation to the anatomy in obese patients [15]. Additionally, there are medical concerns, such as a decreased pulmonary reserve, medical comorbidities, and other anesthetic risks [16].…”