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Excess Weight Poses Anesthesia Challenge
Date:1/19/2010

Obese patients can take steps to minimize risk, experts say

TUESDAY, Jan. 19 (HealthDay News) -- Many health risks of excess weight are well-known, such as heart disease, high blood pressure and diabetes, to name a few. But an obese patient is also a challenge for an anesthesiologist to care for during surgery.

"At least 30 percent of our patients are obese," said Dr. Kumar Belani, a professor of anesthesiology at the University of Minnesota School of Medicine in Minneapolis, who wants to raise awareness about potential complications that they face.

Even though a recent report has found obesity rates leveling off in the United States, about 34 percent of U.S. adults are still obese, according to the U.S. Centers for Disease Control and Prevention. Anesthesiologists who care for these patients say they are medically problematic for many reasons, and the American Society of Anesthesiologists has launched a public education campaign.

If patients are more aware of the challenges, the thinking is, they can work together with the physicians to help minimize risk.

"It's important for the patient to be educated that as far as anesthesia, obesity has an effect," said Dr. Martin Nitsun, a clinical assistant professor of anesthesia at the University of Chicago Pritzker School of Medicine and a staff anesthesiologist at NorthShore University HealthSystem in Evanston, Ill.

An obese patient is likely to have many health problems, including a higher rate of high blood pressure, heart disease, diabetes and a condition called sleep apnea, in which breathing pauses during sleep, Nitsun and Belani said.

Monitoring of vital signs during surgery and anesthesia is crucial, but made more difficult when patients are obese. For instance, veins can be harder to locate, making starting the IV line difficult. Finding a blood pressure cuff that fits the arm can be challenging. In those with apnea, the airway obstruction can cause decreased air flow even with a small amount of anesthetic sedation.

Inserting a breathing tube can be more difficult because of the obese person's anatomy, Nitsun said.

After the surgical procedure, obese patients may be more susceptible to the effects of pain medicine, Nitsun said. "Narcotic pain medicine can depress breathing," he said. That's a concern, as obese patients often already have breathing difficulties just because of the excess weight.

Obese patients facing the need for anesthesia can take a number of risk-reducing steps, both doctors said.

Meeting with the primary doctor or surgeon and the anesthesiologist, if possible, is wise, Belani said.

Often, a patient will meet the anesthesiologist only the day of surgery, Nitsun said, but "we are always available," he added, and a patient can specifically ask to talk to the anesthesiologist.

The patients can "make sure they are medically optimized," Nitsun said. Or, as he calls it, "as tuned up as they can be before coming to surgery."

For instance, a patient who uses a breathing machine called CPAP (continuous positive airway pressure) at home for sleep apnea should ask the doctor about bringing it along if the surgery will be done on an outpatient basis, Belani said.

Ask, too, if any additional tests should be done. For instance, if obese patients are unsure of their diabetes status, screening before surgery would be wise, Belani said.

Patients can also ask if the facility they are going to is "bariatric friendly," Belani said. That means the facility has the right-sized operating tables, gurneys and blood pressure cuffs. More do, because of the growing population of obese people, he said.

If there is sufficient time before the surgery, patients should attempt to lose weight, agreed Belani and Nitsun.

What percent loss might make a difference?

"It's hard to tell," Belani said. But he suspects that "any amount of weight loss as long as it's done in a healthy way would be good."

More information

To learn more about the types of anesthesia, visit the American Society of Anesthesiologists.



SOURCES: Martin Nitsun, M.D., clinical assistant professor of anesthesiology, University of Chicago Pritzker School of Medicine and staff anesthesiologist, NorthShore University HealthSystem, Evanston, Ill.; Kumar Belani, M.D., professor of anesthesiology, University of Minnesota School of Medicine, Minneapolis; American Society of Anesthesiologists


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