The current rise in obesity levels is a global health epidemic that has implications in various aspects of well-being. While there are obvious consequences such as cardiovascular issues and type 2 diabetes, there's also an often-overlooked aspect: the impact of obesity on anaesthesia. As the prevalence of obesity rises, so does the complexity of administering anaesthetic to individuals with these higher weights. In this blog post, we delve into the risks obesity can pose in relation to anaesthesia, highlighting the challenges faced by both patients and medical professionals.
Understanding Obesity and Anesthesia:
Obesity often leads to changes in drug distribution and metabolism which can heighten the risk of adverse reactions. Therefore, anaesthetists have to carefully navigate challenges posed by patients living with obesity to ensure safe and effective administration of the drug.
Difficult Airway Management: Anaesthesia involves the delicate balance of inducing unconsciousness while maintaining a patient's ability to breathe. In obese individuals, excess adipose tissue can accumulate around the neck and throat, making airway management more challenging (Sharma & Pollard, 2015). This is one of the biggest risks as it can affect both the placing of the breathing tube for the surgery (Sharma & Pollard, 2015) and can increase the likelihood of obstructive sleep apnoea (Ebert & Novalija, 2011). This anatomical complexity can require specialised equipment and procedures to reduce the risks.
Increased Oxygen Consumption: Obesity causes issues with respiration and lung capacity. The weight around the abdomen puts pressure on the lungs, potentially leading to challenges in maintaining optimal oxygen levels. This heightens the body’s demand for oxygen, which combined with the issues outlined above- particularly that of sleep apnea- can elevate the risk of hypoxia (Wynn-Hebden & Bouch, 2020).
Cardiovascular Strain: People living with obesity are more likely to suffer from cardiovascular conditions and hypertension due to the increased strain high body mass puts on the cardiovascular system. Anesthesia further exacerbates the stress on this system, posing a heightened risk of complications such as heart attacks and arrhythmias (Royal College of Anaesthetists, 2023).
Delayed Recovery and Prolonged Hospitalisation: Obesity can impact the body’s interaction with anaesthetic drugs which can delay recovery due to several factors. One of these factors relates to the high doses of anaesthetic these individuals have to receive combined with their increased amounts of adipose tissue. The drug can diffuse into this tissue once administration has been stopped, prolonging its release into the bloodstream. This results in a slower clearance of the drugs from the body, and extended sedation (Thomas, Martin, & Pollard, 2020). Obesity can also increase the risk of postoperative complications such as infections and deep vein thrombosis (Saravanakumar, Rao & Cooper, 2006).
Conclusion
As the obesity epidemic continues to grow, anesthesiologists and healthcare professionals must adapt to the evolving landscape of patient care. As well as the above, there are many other significant risk factors that obesity poses on the use of anaesthetics. Recognising and understanding the relationship between obesity and anaesthesia is crucial for mitigating risks and ensuring the safety of individuals undergoing surgical procedures.
References
Ebert, T. J., & Novalija, J. (2011). Morbid obesity and obstructive sleep apnea: the challenging link. The Open Anesthesia Journal, 5(1).
Thomas, E., Martin, F., & Pollard, B. (2020). Delayed recovery of consciousness after general anaesthesia. BJA education, 20(5), 173-179.
Royal College of Anaesthetists. (2023). Anaesthesia and your Weight [Leaflet].
https://rcoa.ac.uk/sites/default/files/documents/2023-12/13-YourWeight2023web.pdf
Saravanakumar, K., Rao, S. G., & Cooper, G. M. (2006). Obesity and obstetric anaesthesia. Anaesthesia, 61(1), 36-48.
Sharma, S., & Pollard, R. (2015). Anaesthetic risks if you have a high Body Mass Index (BMI) [Leaflet]. Oxford University Hospitals NHS Trust.
https://www.ouh.nhs.uk/patient-guide/leaflets/files/11849Pbmi.pdf
Wynn-Hebden, A., & Bouch, D. C. (2020). Anaesthesia for the obese patient. BJA education, 20(11), 388.
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