The patient with obesity and super-super obesity: Perioperative anesthetic considerations

Abstract

Obesity is associated with increased morbidity and mortality related to many complex physiologic changes and the rise worldwide has had far ranging implications in healthcare. According to the World Health Organization, over 2.8 million people die each year from being overweight or obese. Patients who are obese often need surgical procedures or interventional pain procedures and are at higher risk of complications. Patients with super-super obesity are those with body mass index greater than 60 kg/m 2 and are at even greater risk for complications. The present investigation reviews epidemiology, pathophysiology, and anesthesia considerations for best practice strategies in managing these higher risk patients. Clinical anesthesiologists must utilize careful assessment and consultation in developing safe anesthesia plans. Improvements in technology have advanced safety with regard to airway management with advanced airway devices and in regional anesthesia with ultrasound-guided nerve blocks that can provide increased flexibility in formulating a safe anesthetic plan. As well, newer drugs and monitors have been developed for perioperative use to enhance safety in patients with obesity.

Styletubation in Bariatric Surgery: A Case Report

“…Bariatric surgery is the most effective therapy to treat this and is sometimes the last resort in efforts to lose weight. Expectedly, anesthesia and peri-operative management for bariatric and non-bariatric surgeries in all categories of the obese patient populations have become focus issues up for discussion [ 1 , 2 , 3 , 4 ]. Among all the relevant peri-operative management, airway management in such obese populations has been extensively discussed in the literature.…”

Challenges of Super-Super Obese Patient Presenting for Neurosurgery: A Case-Based Review

“…3 Routine assessment of the airway using the Mallampati and upper lip bite tests are nonspecific in patients with underlying super-super obesity and acromegaly. 1,4 The Southwick and Katz scoring system provides a better guide in the assessment of the airway in these patients. 5 Moreover, acromegalics also present with difficult mask ventilation due to macroglossia, prognathism, and enlarged nose.…”

“…3 Adequate analgesia with PCA has been found to improve patient outcome with reduced complications in these patients. 1,3…”

“…Super-super obesity is defined as a body mass index (BMI) of the patient greater than 60 kg/m 2 . 1 The prevalence of severe obesity comprising super and super-super obesity has nearly doubled from 4.7 to 9.2%, suggesting an inevitable encounter of super-obese patients presenting for nonbariatric surgeries. 1 Their perioperative management has been reported earlier only in the context of bariatric surgeries.…”

“…1 The prevalence of severe obesity comprising super and super-super obesity has nearly doubled from 4.7 to 9.2%, suggesting an inevitable encounter of super-obese patients presenting for nonbariatric surgeries. 1 Their perioperative management has been reported earlier only in the context of bariatric surgeries. 2 Due to lifestyle changes, associated endocrine dysfunction, and Cushing's syndrome secondary to preoperative steroids, there is an increase in the number of super and super-super obese patients presenting for nonbariatric surgeries, including neurosurgery.…”