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

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

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

Obesity and mortality Young BMI>45 Age 14 20 30 40 50 12 YEARS OF LIFE LOST 10 8 BMI 36 6 4 2 0 44 ≥ 45 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 BMI Source: Years of life lost due to obesity. JAMA 2003;289:187.

Risks or Comorbidities Causes 1 Risks • Centre (team 3 ) • IHD • OS-MRS 2 • Respiratory • DM Risks: Score: • OSA BMI>50 0-1 = 0.2% Age>45 2-3 = 1.1% • Clotting BP 4-5 = 2.4% Male DVT/PE/OSA 2 DeMaria EJ et al. Ann Surg, 2007 3 Courcourlas , Schubert Obesity Surg 2003 1 Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery N Engl J Med 2009

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

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

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

Why not ? • MDT • PAAC • NHS • Private • Cost • Lack of insight • SOBA recommends

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

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

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

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

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