Ciara Jean Murphy
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34y Female
Fell dislocated knee
182 cm/153 kg BMI 47
Resultant vascular injury
Poor wound healing
Multiple trips to theatre
Difficult Venous Access
Poor Respiratory Reserve
Potentially difficult central neuraxial block or
peripheral nerve block
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BMI <18.5 = underweight
BMI 18.5-25= ideal
BMI 25-30= overweight
BMI 30-35= obese
BMI 35-55 = morbidly
obese
BMI >55=super morbidly
obese
The distribution of fat is
important also
Anaesthesia 2001
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In 2005 >300 million people worldwide were
obese
By 2025:predicted trends 50% of people living
in the USA will be obese
Here: 39% of adults are overweight with 18%
obese
By 2050: predicted 90% of females will be
overweight
Slightly higher in males
Slightly higher in lower socio-economic
groups
Department of Health & Children 2007
 Airway
- OSA
- BMV (BMI > 26)
- Intubation (40cm 15%, 60cm 35%)
 Breathing↓FRC exponentially with BMI
Ventilation (↓ compliance 30%)
Circulation
• Hypertension
• Ischaemic Heart Disease
• Hyperlipidaemia
• Cardiac Failure
• Cardiomyopathies
• Arrythmias
Post Operative Mortality is X2 non obese patient
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Commonly undiagnosed
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> 70% of obese patients
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Problems typically occur
on 2nd/3rd postoperative
night
REM Rebound
of diabetes
 Tight peri-operative glycaemic control
 Poor nutritional status
 GORD
  risk of thrombo-embolic events
  risk of 2 DVT & PE
 Mechanical & Pharmocological
Thromboprophylaxis
 incidence
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AAGBI Guidelines 2007
Obese patients should
only be anaesthetised
in appropriate
locations
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Equipment
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Trained Personnel
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“Obesity Pack” for outof-hours
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Analgesia
Avoidance of Opioids
Central Neuraxial/Regional Analgesia
Multi-Modal
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OSA
Nurse Sitting Up
CPAP
Oxygen
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Identify patients at high risk for Ambulatory
Surgery/St Josephs
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Optimisation
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Further Investigations
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Organisation in Advance of Equipment
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Guidelines differ locally but patients with a BMI <35
are generally considered suitable
BMI >35 should be reviewed by a specialist before
acceptance
BMI 35-38 may be suitable
BMI 38-40 certain procedures & second review
BMI > 40 not recommended
St Josephs > 35
Acceptable if management would not be modified by
inpatient admission
Acceptable if no increased risk can be identified
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Peri-operative Management of the Morbidly Obese
Patient AAGBI 2007
Davis KE, Houghton K, Montgomery JE (2001)
Obesity in Day Case Surgery Anaesthesia 56 (11)
1090-1105
Report of the National Taskforce on Obesity: Obesity
the policy challenges (2007) Department of Health &
Children
Peri-Operative Management of the Morbidly Obese
Patient AAGBI 2007