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How Heavy Is Too Heavy?
Don't push the safety envelope when caring for obese patients.
Ashish Sinha
Publish Date: May 22, 2014
OR Excellence
Ashish C. Sinha, MD, PhD Ashish C. Sinha, MD, PhD

Speaker Profile

  • Board-certified anesthesiologist practicing at Hahnemann University Hospital in Philadelphia, Pa.
  • Served as an editor for "Anesthesia in the Obese Patient."
  • President, International Society for the Perioperative Care of the Obese Patient, 2011-13.

What does anesthesiologist Ashish C. Sinha, MD, PhD, know about caring for overweight individuals? He's anesthetized a patient who weighed more than 800 pounds and another with a body-mass index of 110. In his presentation "How Heavy Is Too Heavy?" the associate professor in the department of anesthesiology and perioperative medicine at the Drexel University College of Medicine in Philadelphia will talk about how to manage the increasing number of overweight patients you're likely to see in your ORs. The dynamic speaker sat down with us recently to discuss the expertise he'll share at OR Excellence.

  • A growing concern. Patients who present for clinical care, and especially to the OR, over the last decade have gotten older, sicker and especially heavier. Two-thirds of the nation's population is overweight or obese, which is reflected in the patient traffic you see coming through ORs. In fact, you might see more heavy patients because normal-weight individuals are getting sick less and requiring less surgery. Obese patients bring unique challenges for caregivers, including ensuring the appropriate furniture and equipment is in place, from large seats in the waiting area to special wheelchairs and OR tables that can safely handle patients in the 400- to 600-pound range, and perhaps even heavier.
  • The importance of a plan. The best way to manage the obese patient is to have plans B, C and D ready to go in the event something goes wrong. If difficult airway warning signs are apparent during pre-op assessments, ask an airway expert to assist during the procedure. Use short-acting drugs and dose slowly — don't paralyze patients if you can't ventilate and intubate them. Have a supraglottic airway device readily available. It doesn't have to be opened and lubed, but you shouldn't be slamming drawers trying to find it during emergent situations.
  • Pain management. Overweight patients have difficulty metabolizing medications, which makes pain control challenging. Avoid using narcotics in order to lower the risk of respiratory depression. The obese have smaller functional reserve capacity and larger metabolic demand, so whatever reserve they have is used up very quickly. A multimodal pain control plan is best in patients with a small margin of safety.
  • So how heavy is too heavy? The cutoff shouldn't be based on total weight or BMI. It depends on the comorbidities the patient has and the care plan you have in place. Is your surgical team expert in caring for obese patients? Do you have the proper equipment? Do you have quick access to a hospital?
  • The new normal. Is caring for obese patients a matter of taking unnecessary risks and being lucky? When we've successfully managed obese patients 75 times before running into an issue during the 76th case, was it a disaster waiting to happen or a lightning strike?
  • Being kind and considerate. You must be sensitive to the emotional state of obese patients. These patients have feelings, and have probably been ostracized in many situations in the past. In fact, that might be a factor in why they've delayed seeking medical help. Don't treat heavy patients as if they're guilty of gluttony. You don't know their situation, you haven't walked in their shoes, you don't know their mental makeup, you don't know how their endocrine system works — you simply have no idea why they're overweight. It's easy to sit in judgment and say something inappropriate, but that's never acceptable.
  • Ashish C. Sinha, MD, PhD
  • What will you tell attendees? I'll discuss the unique challenges of morbid obesity and how they can be managed in the perioperative setting. I want attendees to take home the principles of care I've developed in treating the morbidly obese and use them to care for patients who might weigh much less. They don't have to avoid caring for the obese, but they must understand doing so requires proper planning and preparation.