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Anaesthesia and BMI    Recovery Complications in     Patients with higher BMI
Origins ofAnaesthesia    an ~ withoutaesthesis ~ sensation
Origins of Anaesthesia  First AnaesthesiaOpium poppy capsules   (herbal remedy) 4200 BC Sumerian       Empire
General AnaesthesiaThe Common Forms of General Anaesthesia              • Analgesia              • Hypnosis              •...
Modern AnaesthesiaMorpheusThe Greek God of dreams                                     Morphine                            ...
Analgesic Agents                         Non Opioid•   Barbiturates         Thiopental•   Benzodiazpines        Midazolam ...
Analgesic Agents         Non-Opioid Based              Midazolam              LorazepamUsed to induce general anaesthesia ...
Analgesic Agents              Opioid Based               Fentanyl              RemifentanilUsed for the relief of pain in ...
Obesity Defined• A condition in which the natural energy reserve,  stored in the fatty (adipose) tissue of humans,  exceed...
Obesity andAnaesthesia         Complications in            Recovery           Fellow Travellers . . .     •   Hypertension...
Obesity Risks•   Obesity has been identified as a significant risk factor in    anaesthesia•   BMI is only a guideline: Do...
Airway Problems in          RecoveryNormal Airway – Low BMI   Restricted Airway – High BMI
Airway Problems in    Recovery               Adipose Tissue Problems         • Anaesthetics are “Lipophilic”         • Lip...
Airway Problems in    Recovery               Adipose Tissue Problems         • Anaesthetics released back into blood      ...
Airway Problems in    Recovery               Adipose Tissue Problems         • Anaesthetics and Patient Posture         re...
Posture Problems in    Recovery              Attention to Posture          Adopt: Semi recumbent Positioning          Enco...
The Unexpected                Drug dynamics       Obesity affects drug performance and                   effectiveness    ...
Conclusion•   Beware of abnormal patient recovery•   Anaesthesia affects people differently, especially higher BMI rated p...
Thank you for your    attention          ~ A teaching session ~  Mark G. Hopewell: Under Graduate Adult      Student Nurse...
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Anaesthesia Presentation

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Anaesthesia Recovery Complications in Patients with higher BMI

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Anaesthesia Presentation

  1. 1. Anaesthesia and BMI Recovery Complications in Patients with higher BMI
  2. 2. Origins ofAnaesthesia an ~ withoutaesthesis ~ sensation
  3. 3. Origins of Anaesthesia First AnaesthesiaOpium poppy capsules (herbal remedy) 4200 BC Sumerian Empire
  4. 4. General AnaesthesiaThe Common Forms of General Anaesthesia • Analgesia • Hypnosis • Amnesia • Relaxation
  5. 5. Modern AnaesthesiaMorpheusThe Greek God of dreams Morphine (Purified Alkaloid) Potent opiate analgesic drug. Also a natural endocrine product found in humans and other animals. Morphine acts on the central nervous system (CNS) to relieve pain,The efficacy of opioids have indicated that, in the management of severe pain, no other narcotic analgesic, other than Fentanyl (which has a higher potency, but is shorter acting), is more effective or superior to morphine.
  6. 6. Analgesic Agents Non Opioid• Barbiturates Thiopental• Benzodiazpines Midazolam Larazepam Diazepam• Propofol The most common IV drug to induce and maintain analgesia
  7. 7. Analgesic Agents Non-Opioid Based Midazolam LorazepamUsed to induce general anaesthesia but NOT pain relieving!!
  8. 8. Analgesic Agents Opioid Based Fentanyl RemifentanilUsed for the relief of pain in anaesthesia
  9. 9. Obesity Defined• A condition in which the natural energy reserve, stored in the fatty (adipose) tissue of humans, exceeds healthy limits.• Definition:- Body Mass Index (weight divided by height squared) 30 kg/m2 upwards in Obesity
  10. 10. Obesity andAnaesthesia Complications in Recovery Fellow Travellers . . . • Hypertension • Cellulitis • Delayed Wound Healing • Fatty Liver • Type 2 Diabetes • Delayed Gastric Emptying • Sleep Apnea • Gall Bladder Disease
  11. 11. Obesity Risks• Obesity has been identified as a significant risk factor in anaesthesia• BMI is only a guideline: Does not account for wide variations in body fat distribution and may not correspond to same degree of fatness in different people• Any extra fat deposited in the body demands its share of cardiac output. Every 100g of fat deposited increases cardiac output by 50 ml per minute (or roughly quarter of a cup of water)
  12. 12. Airway Problems in RecoveryNormal Airway – Low BMI Restricted Airway – High BMI
  13. 13. Airway Problems in Recovery Adipose Tissue Problems • Anaesthetics are “Lipophilic” • Lipophilic means “absorption in fats” • Anaesthetics stored in adipose tissue!
  14. 14. Airway Problems in Recovery Adipose Tissue Problems • Anaesthetics released back into blood • Effect: Resedation! • Be prepared! (Know your A.B.C’s!!) •Perform head-tilt / jaw thrust • Nasal / Oral airways nearby
  15. 15. Airway Problems in Recovery Adipose Tissue Problems • Anaesthetics and Patient Posture reduce vital capacity and diaphragmatic excursion • Effect: Hypoventilation and atelectasis (partial lung collapse!) • Solution: Address pulmonary function!
  16. 16. Posture Problems in Recovery Attention to Posture Adopt: Semi recumbent Positioning Encourage: Coughing, deep breathing, early ambulation Nausea risk: Pulmonary aspiration of gastric contents because of increased abdominal pressure, reflux and increased gastric volume
  17. 17. The Unexpected Drug dynamics Obesity affects drug performance and effectiveness Excess Fats and Cholesterol block action of drugs Greater kidney mass increases renal elimination diminishing drug effectiveness
  18. 18. Conclusion• Beware of abnormal patient recovery• Anaesthesia affects people differently, especially higher BMI rated people• Anaesthesia is held in adipose tissues and can be released back into the blood stream, causing more sedation and slower recovery times.• Prepare for emergencies, especially cardio and pulmonary complications – Know your ABC’s!• Consider Posture in high BMI patients ~ Semi Recumbent Position if possible• Appreciate the physiology of high BMI patients and the effects on drug dynamics
  19. 19. Thank you for your attention ~ A teaching session ~ Mark G. Hopewell: Under Graduate Adult Student Nurse ~ Cohort Sept 05 Venue Kidderminster Intervention Suite June 2008

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