Patient (condition)
 
Aliases:
Obese
Morbidly Obese
Super Morbidly Obese
Ultra Morbidly Obese
Fat
Obesity
Obese patient

Topic aliases are alternate phrasings for a particular topic.


Categorised according to the patient's body mass index (BMI) (kg/m2):
Overweight 25-30;
Obese 30-35;
Morbidly Obese 35-55;
Super Morbidly Obese 55-70;
Ultra Morbidly Obese >70

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Flowchart summarising cardiovascular changes and aetiology of cardiomyopathy in obese patients from refl.in/ko

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Ideal body weight (IBW):
Male = (height in cm-100).
Female = (height in cm-105)
refl.in/4v

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Type II diabetes mellitus (NIDDM) is common in this population. Enquire about medication and complications of the disease, and consider withholding metformin for all but minor procedures. See NIDDM

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Unreliable non-invasive blood pressure (NIBP) with large arms, consider intra arterial line where applicable

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


At elevated risk of pressure areas, (although not peripheral neuropraxias), so frequently check and reposition patient.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Consider the risk of aortocaval compression in the hypotensive obese patient and place them in a >15 degree tilted position if required.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Ensure table is correct size and rated to an adequate weight for the patient

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


LA doses to be reduced by 25% for subarachnoid & epidural blocks as engorged epidural veins/fat impinge on the epid space refl.in/4t

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Modified RSI technique for patients requiring intubation, & determined not to be at risk of full stomach. Goal is to reduce the consequences of a "can't intubate, can't ventilate" scenario. 25 degree head up to optimise preoxygenation (addit ~50secs of apneoic oxygenation), and "ramped" position (to optimise airway for laryngoscopy). Commence with min 3 mins good preoxygenation. Induce with propofol and suxamethonium to achieve anesthesia and profound muscle relaxation (and short acting opiate if required). If difficult laryngoscopy is encountered, the optimal positioning & adequate prolonged apnoeic preoxygenation means that there is more time available for use of alternative airway devices, and more time to wake the patient up in the "can't intubate, can't ventilate" scenario

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Oct 10, 2011
The time to return of spontaneous ventilation following suxamethonium is 4.1-7.0 minutes. This means that despite best efforts, the apnoeic oxygenation is not guaranteed to outlast the suxamethonium.
Obese patients are at high risk for obstructive sleep apnoea OSA. Consider the risk of post operative opioid respiratory depression and maximise the use of non-opioid analgesia. refl.in/ko

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Difficult bag mask ventilation is common. Ensure adequate airway adjuncts are immediately available. High pressure mask ventilation may result in gastric insufflation, increasing the risk of gastric regurgitation as well as post-operative nausea and vomiting.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , Pieter Peach , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


If limited recovery staff, consider taking patient out in lateral position preemptively in case patient's airway obstructs & needs rolling

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , Pieter Peach , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Preoxygenation Is More Effective in the 25 degrees Head-up Position Than in the Supine Position in Severely Obese Patients. refl.in/35

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , Pieter Peach , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Consider the presence of a second anesthesiologist at induction as a second pair of hands in potentially difficult cases.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Delivery of oxygen via a nasal cannula during difficult laryngoscopy in obese male patients in a head up position prolongs apneoic oxygenation time from 3.5min to 5.5min. refl.in/ks

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Every 1cm neck circumference above 40cm increases odd ratio of difficult laryngoscopy by 1.16 #ref

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Exaggerated reduction in FRC under general anesthesia. Reduction of 50% compared with 20% for non-obese patients. refl.in/ko

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Functional residual capacity (FRC) is more likey to fall below closing capacity (CC) resulting in ventilation perfusion mismatch. Patients will require higher peak expiratory pressures (PEEP) to avoid this. Image from refl.in/ko

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Some anesthetists regard obese patients to be at risk of gastroparesis/delayed gastric emptying, increasing the risk of pulmomary aspiration of gastric contents.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Sep 08, 2014
Evidence? refl.in/ar suggests otherwise
Patients with diastolic dysfunction have a fixed stroke volume, and are more reliant on heart rate for cardiac output.

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


"Succinylcholine given in a dose of 1.0 mg/kg based on total body weight provides complete neuromuscular paralysis and predictable tracheal intubating conditions in morbidly obese patients. Smaller doses are not as effective." refl.in/kp

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Dose of propofol for both induction & maintenance of anesthesia in obese patients should be based on actual body weight refl.in/4u refl.in/4w

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


In morbidly obese patients, the induction dose of propofol can be calculated on ideal body weight IBW. refl.in/4v

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


Obesity does not increase peri-operative risk in elective general surgical patients. Cohort of 6336 patients. refl.in/ij

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only


1
Residual gastric volumes after 8hr fast in obese patients are the same as lean patients. refl.in/ar

Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.


Cancel
attachment
Endorsed by , more...
Locksmallsmush Private
Locksmallsmush only
Locksmallsmush only