Anesthesia and the Morbidly Obese

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I was reading an article the other day about how hospitals are incorporating a lot of the design features that have been used specifically for bariatric patients in other areas of the hospital because of the high rate of obesity in other patient populations.

Are there specific considerations for patients undergoing bariatric surgeries? Has bariatric experience changed the practices of other surgeries involving obese patients? Do more patients get cleared for elective surgery now that would have been delayed due to weight before?

What are the specific needs unique to morbidly obese patients, for any type of surgery? Hoping to get a clinical discussion going. :)

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We were actually having this exact conversation at my clinical site within the past month...

the problem we are encountering is that the patients sched. for bariatric surgery are CORRECTLY worked up - ie: pft's, sleep studies, cardiac clearance etc...

however - the multitude of other morbidly obese patients that we are doing general surg (gyn etc...) are NOT worked up in the same way - but should be based on weight and health status...so bariatric surgery is teaching everyone a thing or two about how these patients should be handled- of course it is not easy to evoke change....

we will see what comes of it.

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Lipid solubility and partition coeficients come to mind...

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clinically relevant things to consider w/ morbidly obese

- higher incidence of OSA (and all the comorbid conditions associated w/ OSA)

- if not positioned correctly (and sometimes even when positioned correctly - diff ventilating and or intubatins

- should always have FO on hand

- positioning

- management of narcs esp w/ OSA patient

-slower GI emptying

- usually have GERD

- no FRC - desat in a heartbeat

-iso especially will hang around longer

- knowledge of which drugs should be based on IBW and which ones should be actual BW

-every lb of fat has 300meters (i think is correct) of vasculature - that is alot of extra work for the heart already

- ??NIDDM??

- thyroid status

-CV status

- smoker??

as you can see - there are many considerations that are unique to the morbidly obese patient - i am sure i missed many

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