Implications for Anaesthesia Dr Jonathan Cousins FRCA FFICM - - PowerPoint PPT Presentation

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Dec 02, 2022 47 likes •220 views

NCEPOD Implications for Anaesthesia Dr Jonathan Cousins FRCA FFICM Vice-Chairman of SOBA Society for Obesity and Bariatric Anaesthesia UK Anaesthetic aspects of bariatric surgery Impact of this report on anaesthesia SOBA Who are we

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Society for Obesity and Bariatric Anaesthesia UK

NCEPOD Implications for Anaesthesia

Dr Jonathan Cousins FRCA FFICM Vice-Chairman of SOBA

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Anaesthetic aspects of bariatric surgery Impact of this report on anaesthesia

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SOBA

Who are we
Why are here
When do we meet
We do…..

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Anaesthesia

Obesity – widespread ?
Nuisance
Traditional teaching in context
BMI 49
BMI 57 = 17 Stone extra

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Obesity and mortality

Age

2 4 6 8 10 12 14 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 ≥ 45

BMI

YEARS OF LIFE LOST

20 30 40 50

Source: Years of life lost due to obesity. JAMA 2003;289:187.

Young BMI>45 BMI 36

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1Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery N Engl J Med 2009

Risks or Comorbidities

Causes1

IHD
Respiratory
DM
OSA
Clotting

Risks

Centre (team3)
OS-MRS2

2DeMaria EJ et al. Ann Surg, 2007 3Courcourlas , Schubert Obesity Surg 2003

Risks: BMI>50 Age>45 BP Male DVT/PE/OSA Score: 0-1 = 0.2% 2-3 = 1.1% 4-5 = 2.4%

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MDT

45% Cases were reviewed
Who else was ---- missing ??
Bariatric Physicians !
Psychiatric Support !
WhatCANwe bring to the MDT ?

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Investigations

CT/MRI
Screening for OSA
Cardiac opinions
Parity with the USA ?
Investment in facilities
SOBA recommends

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Pre-Anaesthetic Assessment Clinic

Most went to PAAC
Only 68% didn’t see anaesthesia
19% assessments were inadequate
ASA – no link to PAAC use
ASA and OS-MRS
SOBA recommends

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Why not ?

MDT
PAAC
NHS
Private
Cost
Lack of insight
SOBA recommends

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Anaesthesia

Only 3 % had problems
Airway and low blood pressure
Appropriate equipment
Well monitored throughout
nb NAP4 + SOBA

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1 IHAS-Clinical Guidelines for the establishment of a bariatric service Oct 2012

Critical Care

28% elective use of L2/3 beds
2.8% unexpected usage
Split private and NHS provision
NCEPOD recommends policy
SOBA supports IHAS 1 and policy

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After surgery

70% go to ward beds
Tracking was poor
Care was poor in 10%
Experience
Misdiagnosis

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Anaesthesia Summary

Safe
High Standards seen
As surgical field progresses
Unit evolution is needed

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SOBA Recommendations

MDT onwards involvement
High risk case review essential
Post-Op care to be improved
IHAS guidance
Sensible experience

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