Pediatric obesity and perioperative medicine
- Challenges of defining and classifying perioperative obesity
- BMI is imperfect but is the most widely used
- Positioning and vascular access
- risk of injury to self, due to awkward positioning, as well as to patient
- potential for increased reliance on secure device e.g., CVC
- Perioperative implications
- increasing trend in obesity
- need to educate patients and families about risks and counsel them
- risk mitigation e.g., weight reduction, treat OSA, hypertension, reflux, asthma
- increased awareness of perioperative obesity risks is essential for rescue processes when complications occur
- higher risk of perioperative respiratory adverse events
- higher risk of surgical site infections (x2)
- risk of venous thromboembolic events (mainly studied in adults)
- anaesthetic medication tends to be dosed outside the recommended range
- antibiotic dosing can be difficult due to delayed gastric emptying, increased volume of distribution, and decreased hepatic and renal clearance
- obesity is associated with increased long-term opioid use, can consider opioid-sparing techniques
- Research gaps
- consider delivering nutrition and healthy lifestyle information to parents during the surgical visit
- emerging data of higher rates of being overweight and obesity in patients with physical/neuro-cognitive disability
- questions of which index of adiposity should be used (BMI vs abdominal/neck circumference), induction of anaesthesia (inhalational vs intravenous), pain assessment, emergency agitation in the obese child with disability etc. remain mostly unanswered
Reviewed by Dr Solomon C. Yogendran
