Anaesthesia for the obese patient

Beware of:

‘Apple’ fat distribution (central obesity)

Metabolic syndrome (3 of central obesity, hyper-tension, cholesterol, sugars, lipids)

 

Tips:

Pre-op: STOPBANG >5 = high risk of disordered breathing/OSA

AR: Consider test dose of 50mcg fentanyl pre-induction for sensitivity for opioids

RSI: No evidence

Drug dosing: Ideally use LBW. Practically IBW + few kg. For all drugs except suxamethonium and neostigmine

Position: Reverse trendelenburg with pillow under shoulders for tragus above sternum, rather than break in the bed

Extubation: consider NPA with lidocaine

Post-op: avoid ‘tying’ to the bed e.g. with a-line, infusions

 

Anticipated Difficult Airway

Remember to consider – to get an idea of what you are dealing with.

Thoughts. Which of the following are anticipated to be difficult and what is the plan for each:

  • Mask ventilation
  • LMA insertion/use
  • Endotracheal intubation
  • Front of neck access

 

Options to consider:

  • AFOI
  • Inhalational induction vs IV induction
  • Spontaneous vs controlled ventilation (+/- muscle relaxant)
  • Mask ventilation with guedel + two person technique
  • THRIVE
  • Direct laryngoscopy
  • Video laryngoscopy
  • Asleep FOI
  • Front of neck: surgical cricothyroidotomy by us vs ENT trache (awake?)