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 Release 21.0, Jan 2008
 
Chapter : ch31. Anesthesiology Section : Preoperative Patient Classification and Preparation
  Preparations for Reducing Perioperative Complications in a Patient with Morbid Obesity

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Copyright (c) 2006-2007, Institute for Algorithmic Medicine, Houston, TX, USA. All rights reserved.

Overview :

A morbidly obese patient is at risk for a number of perioperative complications. These can be reduced by careful preparation and patient management.

 

If the case is elective, then the patient should be encouraged to:

(1) lose weight

(2) exercise

(3) stop smoking if a smoker

 

Potential Complication

Preparation

breakage of operating table and transport device

equipment rated for patient's body weight

decubital ulcer

pressure relief, good nursing care and close monitoring

difficult intubation

equipment for difficult intubation readily available

difficulty in patient transfer

crane for lifting

hyperglycemia

aggressive insulin therapy to maintain normoglycemia

incorrect drug doses

know in advance if dosing should be by actual or ideal body weight

perioperative airway obstruction and/or hypoventilation

monitor oxygenation and carbon dioxide retention, especially if obstructive sleep apnea present; provide rigorous pulmonary toilet with deep breathing exercises postoperatively

perioperative heart failure or ischemia

monitor the ECG and cardiovascular function

post-operative infection (surgical site, pneumonia, UTI)

prophylactic antibiotics, early mobilization, careful wound care

thrombophlebitis with risk of pulmonary embolism

prophylactic anticoagulation, early mobilization

wound dehiscence

secure wound closure, prevention of surgical site infection

 

where:

• It is important not to underestimate the effect of high body weight. For example, a morbidly obese patient can crush a plastic bedpan.

 

  References:

Pasulka PS, Bistrian BR, et al. The risks of surgery in obese patients. Ann Intern Med. 1986; 104: 540-546.

 

 

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