Abstract
As a result of the increase in obesity worldwide, healthcare professionals must be able and prepared to manage the morbidly obese patient. This is particularly desirable in emergency settings, where the physical characteristics of these patients pose specific problems. Obese patients often have chronic respiratory, cardiovascular and metabolic comorbidities, which in an emergency cannot be adequately evaluated. Anesthesia and cardiopulmonary resuscitation present particular challenges in obese patients. Specific competencies are essential, as are clinical procedures and pathways tailored to all in-ambulance and in-hospital requirements. Periprocedural assessment and care strategies specifically defined for obese patients are pivotal for reducing morbidity and mortality in emergency surgical situations and critical care settings. Airway management is a crucial component, as are proactive strategies to minimize the risk of pulmonary, cardiovascular and infectious complications.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
ASA Physical Status Classification System. 2014. https://www.asahq.org. Accessed 20 Nov 2018.
Mosier JM, Hypes CD, Sakles JC. Understanding preoxygenation and apneic oxygenation during intubation in the critically ill. Intensive Care Med. 2017;43:226–8.
Levitan RM. NO DESAT! Nasal oxygen during efforts securing a tube. 2010. http://www.epmonthly.com/features/current-features/no-desat. Accessed 15 Nov 2018.
Higgs A, McGrath BA, Goddard C, et al. DAS guidelines on the airway management of critically ill patients. Anaesthesia. 2018;73:1035–6.
Ball L, Hemmes SNT, Serpa Neto A, et al. Intraoperative ventilation settings and their associations with postoperative pulmonary complications in obese patients. Br J Anaesth. 2018;121:899–908.
Petrini F, Di Giacinto I, Cataldo R, et al. Perioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI Consensus. Minerva Anestesiol. 2016;82:1314–35.
National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Knowing the risk: a review of the peri-operative care of surgical patients. 2011. www.ncepod.org.uk. Accessed 21 Nov 2018.
Royal College of Physicians. National Early Warning Score (NEWS). Standardising the assessment of acute-illness severity in the NHS. 2012. www.rcplondon.ac.uk. Accessed 19 Nov 2018.
Sultana A, Torres D, Schumann R. Special indications for opioid free anaesthesia and analgesia, patient and procedure related: including obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, opioid addiction and cancer surgery. Best Pract Res Clin Anaesthesiol. 2017;31:547–60.
Brunette DD. Resuscitation of the morbidly obese patient. Am J Emerg Med. 2004;22:40–7.
Chalkias A, Xanthos T. The obesity paradox in cardiac arrest patients. Int J Cardiol. 2014;171:101–2.
Ma Y, Huang L, Zhang L, et al. Association between body mass index and clinical outcome of patients after cardiac arrest and resuscitation: a meta-analysis. Am J Emerg Med. 2018;36:1270–9.
Kakavas S, Georgiopoulos G, Oikonomou D, et al. The impact of body mass index on post resuscitation survival after cardiac arrest: a meta-analysis. Clin Nutr ESPEN. 2018;24:47–53.
Ogunnaike BO, Whitten CW, Minhajuddin A, et al. Body mass index and outcomes of in-hospital ventricular tachycardia and ventricular fibrillation arrest. Resuscitation. 2016;105:156–60.
Truhlář A, Deakin CD, Soar J, et al. European resuscitation council guidelines for resuscitation 2015: section 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148–201.
Secombe P, Sutherland R, Johnson R. Body mass index and thoracic subcutaneous adipose tissue depth: possible implications for adequacy of chest compressions. BMC Res Notes. 2017;10:575.
Lee J, Oh J, Lim TH, et al. Comparison of optimal point on the sternum for chest compression between obese and normal weight individuals with respect to body mass index, using computer tomography: a retrospective study. Resuscitation. 2018;128:1–5.
Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva. Buone pratiche cliniche per gli accessi vascolari. SIAARTI. 2018. www.siaarti.it/standardclinici. Accessed 19 Nov 2018.
Uppot RN. Technical challenges of imaging & image-guided interventions in obese patients. Br J Radiol. 2018;91:20170931. https://doi.org/10.1259/bjr.20170931.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Cataldo, R., Di Giacinto, I., Sorbello, M., Petrini, F. (2020). Emergency Anesthesia and Resuscitation in the Obese Patient. In: Foschi, D., Navarra, G. (eds) Emergency Surgery in Obese Patients. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-17305-0_2
Download citation
DOI: https://doi.org/10.1007/978-3-030-17305-0_2
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-17304-3
Online ISBN: 978-3-030-17305-0
eBook Packages: MedicineMedicine (R0)