Have you taken a good look at your patients lately? Chances are, they're a lot bigger than they used to be. Do you have the equipment to accommodate them, starting with the all-important OR table? If you're thinking of bulking up your tables, here are some buying tips and a look at your options (see "The Latest in High-capacity Tables" on page 68).

1 Rate the weight
For our bariatric surgery center, our tables needed to have at least 1,000-lb. capacities. You likely won't be treating such morbidly obese patients. The average overweight or obese person who meets criteria for outpatient surgery will probably be fine with a table rated for at least 500 lbs. A note about the difference between weight ratings: If you do orthopedic cases or other procedures that have more strenuous positioning requirements - beach chair and Trendelenburg, for example - check that the minimum weight rating for articulating, not just static, will meet the needs of the overweight and obese as, oftentimes, the two figures differ significantly. Regardless of the high-end capacity, look for a table with a power option; asking your staff to manually push even 300 pounds presents an injury risk that you've no excuse not to avoid.

2 Complete with accessories
You'll likely have to supplement in order to ensure that patients will be well-supported and comfortable. Look for a table that comes with a wide variety of easy-to-use attachments and accessories.

• Width extenders. Depending on the size and shape of the patient, you may need to use table extensions to properly support him. Table extenders should give you enough platform space so that no part of the patient is in danger of hanging off the table.
• Leg and foot support. Especially if you have any reason to position a patient in reverse Trendelenburg, make sure the legs are fully supported. If the knees buckle, it's likely the patient won't be on the table for long. A padded footboard and straps and padding for the ankles help to support the lower body.
• Arm support. Our surgeons have arm cradles to keep patients' arms up, out of the way and supported so that, when the table is up, you've reduced the gravity pulling the patient forward. I can't stress enough that arm cradles and armboards should be well-padded to avoid pressure sores, which overweight and obese patients are prone to due to poor skin circulation (made worse by anesthetics and OR temperatures).

3 Set it low
Look for a table with the lowest minimum height possible. Transferring patients from the stretcher to the table, or from the stretcher to an air mattress to the table, is easier when the OR table can be brought closer to the ground. It's awful hard to transfer patients up rather than down or straight across. (Though you can avoid such potential transfer problems entirely by getting a stretcher-table rated for high weight loads; the drawback here is that these tables can't usually accommodate as much weight as a table.) Also, a lower height lets you reach across the patient - I've seen nurses have to walk around the table when prepping because they can't reach to prep the entire abdomen. Overweight and obese patients, by virtue of their size, add to the table height in a way that average-sized patients don't. This presents a surgeon-comfort issue; if you can sufficiently lower the table, surgeons can work with their hands and arms at the level to which they're accustomed. If you can, have a mock set-up to get an overweight patient on the table you're considering.

The Latest in High-capacity Tables

Advantage Medical Systems
Smart Table
(800) 810-1262
www.advantagemedical.info
Price: Not provided
FYI: The Smart Table offers 500 lbs. of lift and articulation capacity, a tabletop that is two inches wider than standard and the lowest minimum height available, says the company. Other positioning features: Exceptional flex eliminates the need for a kidney bridge; a tapered back section allows better access; a removable full-leg section eliminates the need to move the patient down the table after transfer for lithotomy procedures; and the articulating headrest is equipped with fold-up trays.

Berchtold
Operon D 850
(800) 243-5135
www.berchtoldusa.com
Price: $65,000; $68,000 with InstaDrive
FYI: The Operon D 850 rises to 46.4 inches, lowers to 22.6 inches and offers 1,000-lb. lift and articulation throughout its entire range of motion to accommodate nearly all surgical disciplines, says the company. An integrated X-ray channel, 17-inch longitudinal slide and carbon fiber tabletop make imaging a snap. The hand pendant features a backlit, easy-to-read keypad so surgeons can make adjustments even in low-light ORs. Optional InstaDrive mechanically powers moving and positioning of the table.

Biodex Medical Systems
Surgical C-Arm Table 840
(800) 224-6339
www.biodex.com
Price: $34,000
FYI: The Surgical C-Arm Table 840 features 500-lb. capacity, extra-large radiolucent area, free-float X-Y tabletop, motorized height control, lateral roll, Trendelenburg motions and a catheter tray extension, says the company. A cantilevered, low-attenuation, carbon-fiber tabletop accommodates portable or ceiling-suspended C-arms, and the radiolucent area is free of cross members for full fluoroscopic visualization and unobstructed C-arm positioning. Two-inch-thick table padding, three adjustable Velcro straps and a face cutout for prone positioning help ensure patient comfort and stability.

DRE Medical
Lucerne
(800) 477-2006
www.dremedical.com
Price: $19,995
FYI: The Lucerne features an electro-hydraulic compact mechanism with overload protection (to prevent damage) in the base for precise patient positioning; a radiolucent tabletop for maximum full-body intraoperative imaging (C-arm or X-ray) a detachable mattress, head and leg sections to enhance positioning flexibility; and a maneuverable and stable base with casters for movement in all directions, says the company. A remote control with coiled cable adjusts table height, lateral tilt and back and pelvic sections.

Getinge
Maquet Alphamaxx
(800) 475-9040
www.getingeusa.com
Price: $55,000
FYI: The Alphamaxx offers lift and articulation capacity up to 1,000 lbs. Interchangeable back and leg sections let you customize the table for various patient sizes and procedures, and dual articulating, split-leg plates reduce setup time and provide better surgeon access and comfort, says the company. Low-height capability facilitates patient transfer and intraoperative tableside access. Also available with auto-drive.

SchaererMayfield
Schaerer 7300
(800) 755-6381
www.schaerermayfieldusa.com
Price: $43,500
FYI: The modular Shaerer 7300 can easily convert for use in a variety of surgical specialties. The cantilever design provides imaging access in any position. The power-elevated, independent pelvic tilt feature enhances surgical access to the perineal area without the need to put the patient in Trendelenburg. The 36-inch carbon fiber extension is specifically designed for maximum C-arm access. 500-lb. capacity

Skytron
UltraSlide 3600B
(800) SKY-TRON
www.skytron.us
Price: $58,700
FYI: This top-slide table provides 1,000 lbs. of lift, 800-lb. articulation capacity and full-body imaging capability. Designed for general and bariatric procedures, the UltraSlide 3600B features a 23-inch longitudinal top slide, the ability to lower to 24 inches, 30-degree articulation with full function, removable back and leg sections and a back-lit, one-touch pendant control, says the company. Accessories include bariatric levitator stirrups, side extensions that widen the table top to 30 inches and a 10-inch by 30-inch bariatric footboard.

Steris
Cmax General Surgical Table
(800) JIT-4-USE
www.steris.com
Price: $62,100
FYI: The Cmax surgical table gives you up to 1,100 lbs. of capacity and an 18-inch powered longitudinal slide lets you access the entire body with a C-arm without having to reverse patient orientation on the table, says the company. Some additional features: automatic limit sensors that prevent accidental collisions and articulation conflicts; a hand control that displays table positioning and status information; the IntelliPower system, which provides dual power capability without manual switching; and a radiolucent powered kidney elevator that doesn't obstruct fluoroscopy scans.

Stryker Medical
Vertier Surgical Table
(800) 869-0770
www.stryker.com
Price: $58,500
FYI: The 650-lb. fully articulating, 1,000-lb. static capacity Vertier features a six-section modular table top that holds patients of all sizes while maintaining a small footprint, says the company. Extra large dual casters and an optional fifth wheel increase mobility, says the company, and 16 inches of top slide and an integrated X-ray cassette channel ease imaging access. Additional features include the ability to lower to 25.6 inches, programmable memory buttons, an override panel with separate electronics and Sidne voice-activation compatibility.

Trumpf Medical Systems
Mars Surgical Table
(888) 474-9359
www.us.trumpf-med.com
Price: not provided
FYI: This split-leg, fully articulating table maintains stability at full 790-lb. capacity, even at extreme positioning angles, says the company. The table lowers to 23.6 inches and allows for full-body C-arm imaging thanks to 9.8 inches of longitudinal slide, head-to-toe X'ray channel and carbon fiber components.

VisionEquip
UFSK 600XLE
(888) 783-7891
www.visionequip.com
Price: $12,290
FYI: Rated for 500 lbs., the 600XLE converts from a transportation chair to a surgical table, making it a good choice for ophthalmology and other specialties where it may be safer and more efficient to keep obese patients on one surface, says the company. Featuring a rigid aluminum chassis, stainless steel bed frame, directional steering and electronic braking, the table is powered by pollution-free rechargeable batteries to operate cordlessly for up to 40 procedures.