Chapter 2: Guidelines for the Provision of Anaesthesia Services for the Perioperative Care of Elective and Urgent Care Patients 2024
Ideally, patients with morbid obesity should undergo preassessment by a senior anaesthetist.256
Ideally, patients with morbid obesity should undergo preassessment by a senior anaesthetist.256
Advanced warning of elective patients with morbid obesity should be given to the appropriate ward/ theatre environment by the preoperative assessment team. Additional specialised equipment is necessary and should be available for every patient with morbid obesity at all stages of the perioperative pathway.256
Patients undergoing bariatric surgery should be considered for level 2 or 3 critical care postoperatively.22
Patient dignity should be maintained preoperatively by ensuring appropriate theatre clothing is available in the day case suite or admissions area.
The safe movement and positioning of patients with obesity may require additional staff and specialised equipment.257,258 An operating table, hoists, beds, positioning aids (including for induction of anaesthesia) and transfer equipment appropriate for the care of patients with obesity should be available in appropriate quantities for the caseload, and staff should be trained in its use.256...
In view of the increased technical and clinical risks posed by patient with morbid obesity, senior anaesthetic and surgical staff should manage these patients.260
In the postoperative period, the safety of patients with obesity may be improved by the use of supplemental oxygen, non-invasive ventilation (continuous positive airway pressure), monitoring of sedation, and ideally continuous pulse oximetry.261
Patients with obstructive sleep apnoea have a higher incidence of postoperative complications including hypoxia, renal failure, unplanned critical care stay, and delayed discharge. Therefore, consideration should be given to monitoring such patients in a critical care environment postoperatively.262
Critically ill patients should only be held in the recovery area because of a lack of availability of appropriate facilities elsewhere if recovery staff are appropriately trained, and the recovery unit is appropriately equipped to enable monitoring and treatment to the standard of a level 3 intensive care unit (ICU). In some circumstances, such as a viral pandemic or a...