Obesity in the O.R.—A Weighty Problem for Anesthesiologists

King George Military Hospital, London 1915
Doctor administering anesthesia.
(c) flickr.com/photos/nlmhmd/16086495137

We know that obese patients can expect longer surgery times. Just getting through the fat layers takes more time*; obesity can often double the length of surgery. However, the longer the surgery proceeds, the longer the patient will need to be asleep, and the more anesthesia is necessary.

*Note: Not only does fat make surgery more difficult and extensive, but it also delays healing.

What many people don’t realize, however, and that includes many of my clients with whom I’ve had this conversation, is that the anesthesiologist has a much more difficult situation on his or her hands for surgical patients who carry a lot of extra weight vs. those patients of a healthy weight. It’s not just a matter of “turning up the dial” on an anesthesia machine to let more air out!

Obesity-related changes in anatomy have significant implications for obese patients requiring surgery and anesthesia.

• Finding an appropriate blood pressure cuff to fit a patient’s arm and more difficulty in locating veins.

• Airway management presents special challenges.  Because their airways tend to close when they’re under sedation, obese patients need breathing tubes inserted more often, and getting a tube into their airways is more difficult: Necks are bigger (yes, fat people have fat throats; read Is Your Throat Fat?), so it’s harder for anesthesiologists to see the vocal cords.  Therefore, placement of a breathing tube may require special equipment (such as video assistance) and techniques.

Anesthesiologist using Glidescope video laryngoscope to intubate the trachea of a morbidly obese patient with challenging airway anatomy. (https://commons.wikimedia.org/wiki/File:Glidescope_02)

• Airway obstruction due to Obstructive Sleep Apnea can result in decreased airflow and oxygen in patients receiving even minimal amounts of sedation.

(c) rob3000 Fotosearch_k33784855

• Obesity can double the risk of serious airway issues such as emergency tracheostomy (cutting a hole in the front of the neck into the windpipe to deliver oxygen), admission to the ICU and brain damage.

All of the above complications are compounded by other underlying health problems many obese patients often have, including hypertension, heart disease and diabetes.

Finally, a heavy chest and abdomen also make it more difficult for a patient to take deep breaths after surgery, not only leaving one in a groggy, weakened state for a longer period of time, but also pneumonia is more likely to develop in areas of the lung that don’t fully expand after surgery.

So . . . let’s hear it for the anesthesiologists who have to anticipate all these difficulties, prepare for them and counsel obese patients regarding potential complications.

If you’re obese and contemplating any kind of surgery, help the anesthesiologist by losing some weight . . . and that will greatly help you get through surgery with fewer complications.