The Ongoing Challenges with the Peri-operative Care of the Morbidly Obese Patient
August 2, 2010 2 Comments
Blog Post by Jay B. Brodsky, MD and Harry J.M. Lemmens, MD, PhD, and Stanford University School of Medicine, Stanford, CA, 94305
We are all aware that the world is experiencing an obesity epidemic. Given the great numbers of morbidly obese patients currently undergoing surgery and the predicted increases in those numbers for the future, every health care professional must be familiar with the unique management concerns of these potentially complex patients.
The morbidly obese patient can be especially challenging for their anesthesiologist and surgeon. There are physiologic changes to almost every organ system, numerous associated medical co-morbidities, altered uptake and distribution of anesthetic agents and other drugs, potentially difficult airways, as well as technical difficulties related to the large size of these patients.We believe all anesthesia and surgical training programs should now place a special emphasis on teaching the principles of peri-operative management of obese patients. Even after formal training, health care providers must continue to remain current with new management strategies. For example, the relatively recent introduction of video-laryngoscopes has virtually replaced awake fiber-optic bronchoscopic placement of tracheal tubes in morbidly obese patients. Thus, all anesthesiologists must become familiar with the use of these devices and they should be readily available if a difficult intubation is encountered.
Keeping up to date with current medical journal articles, textbooks, (1) and attendance at continuing medical educational meetings will insure that the clinician is familiar with the strategies for success with these patients. During the past several years medical meetings have been organized that specifically focus on aspects of care of the morbidly obese patient. For anesthesiologists the 2nd meeting of the European Society for the Peri-operative Care of the Obese Patient (ESPCOP) will be held in Pordenone, Italy September 18th, 2010. Later that same week the 3rd annual Chichester Bariatric Meeting, which considers both the surgical and anesthetic care of obese patients, will be held in Chichester, UK.
The WEB is an excellent way of exchanging ideas and sharing experiences. We invite participation by physicians and nurses with an interest in the peri-operative management of the morbidly obese patient to join us in a discussion group. We think that this or the ESPCOP WEB sites would be excellent venues for such a discussion group. We can all benefit from the knowledge and experience of others when it comes to caring for morbidly obese surgical patients.
1. Morbid Obesity: Peri-operative Management. Second Edition. Alvarez A, Brodsky JB, Lemmens HJM, Morton JM (editors). Cambridge University Press, Cambridge, UK. 2010