Central Venous Access and the Obese Patient
You are scheduled to anesthetize a 54-yr-old, 160 kg, 183 cm tall (body mass index = 47.8 kg/m2) man with vasospasm for cerebral angiography. He had been admitted to the intensive care unit 3 d earlier, after an emergency craniotomy for a subarachnoid hemorrhage. When you meet him in the radiology suite, he responds sluggishly to verbal commands, but reacts to pain. His heart rate is regular at 66 beats/min, and the blood pressure is 160/90. The neurosurgeon is happy with that pressure. An endotracheal tube had been removed 12 h previously. He is breathing spontaneously on an oxygen mask, providing 2 liters of oxygen per min. His vital signs are within normal limits. His only IV access is a triple-lumen right subclavian venous catheter (16 cm long) (Arrowgard Blue Plus Multi-lumen CVC; Arrow International, Inc., Reading, PA). This had been inserted at the time of the original operation. Through the proximal lumen of this catheter, IV propofol 100 mcg/kg/min is being infused for sedation. Via the medial lumen, neosynephrine 200 mcg/kg/min is given for pressure support. Maintenance fluid is given through the distal port. You review the previous anesthesia team’s note in their anesthesia record. They report no problem with airway management. Despite that,you make sure you have a fiberoptic cart,bougie, etc., available. You check the anesthetic machine and make sure your anesthesia equipment and all your anesthesia drugs are ready. You call for a colleague to come and give cricoid pressure. He arrives and you look set to start the anesthetic. However, is there something else that you should do before induction of general anesthesia?
KeywordsObese Patient Central Venous Access Verbal Command Anesthesia Record Anesthetic Machine
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