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Anesthesia And Obesity...important facts

Expiratory reserve volume is the most sensitive indicator of the effect of obesity on pulmonary function testing.




Plasminogen activator inhibitor-1 (PAI-1), which is secreted by  adipocytes  associated with visceral obesity inhibits the fibrinolytic system. PAI-1 decreases fibrinolysis and increases the risk of coronary artery disease.

Gastric emptying is delayed in obese patients because of increased abdominal mass that causes antral distension, gastrin release, and a decrease in pH with parietal cell hypersecretion.

The magnitude of body mass index does not have much influence on the difficulty of laryngoscopy.

Neck circumference has been identified as the single biggest predictor of problematic intubation in morbidly obese patients

Preoxygenation in the head-up or sitting position is more effective and provides the longest safe apnea period during induction of anesthesia in obese patients.

Positive end-expiratory pressure is the only ventilatory parameter that has consistently been shown to improve respiratory function in obese subjects

Rhabdomyolysis has been documented in morbidly obese patients undergoing prolonged procedures. Elevations in serum creatinine and creatine phosphokinase levels unexplained by other reasons and complaints of buttock, hip, or shoulder pain in the postoperative period should raise the suspicion of rhabdomyolysis.

Forearm blood pressure is a fairly good predictor of upper arm blood pressure in most patients; however, forearm measurements with a standard cuff may overestimate both systolic and diastolic blood pressures in obese patients.
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