Severely Obese Patients Need Careful Pre-Op Evaluation

12-lead ECG, chest radiograph reasonable in severely obese patients before surgery
By Eric Metcalf
HealthDay Reporter

TUSEDAY, June 16 (HealthDay News) -- Given the growing prevalence of severe obesity in the United States, health care professionals should be aware of the special considerations regarding preoperative cardiovascular assessment and perioperative cardiopulmonary management of such patients, according to an advisory published online June 15 in Circulation.

Paul Poirier, M.D., of the Institut de cardiologie et de pneumologie de Quebec in Canada, and colleagues write on behalf of the American Heart Association that issues of particular concern in a preoperative assessment of obese patients include heart failure, hypertension, deep vein thrombosis, and pulmonary hypertension related to apnea. Polysomnography is warranted in the presence of obstructive sleep apnea symptoms, and stress testing may also be advisable in some patients.

During surgery, desaturation can develop more rapidly in severely obese patients. During tracheal intubation, the use of the 30-degree reverse Trendelenburg position may be safer than the supine horizontal or 30-degree backup Fowler position. Postoperatively, patients who use nasal continuous positive airway pressure ventilation at home should continue its use in the hospital to maintain oxygenation, the authors advise.

"The challenge for the clinician before surgery is to identify the severely obese patient who is at higher perioperative cardiovascular risk. The obtainment of a 12-lead electrocardiogram and a chest radiograph is reasonable in all severely obese patients under consideration for surgery," Poirier and colleagues conclude.

Two co-authors reported work as an expert witness or disclosed financial relationships with relevant companies.

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