Obesity and Concomitant Medical Problems

In evaluating the patient for office surgery the clinician often pays close attention to the specific medical issues associated with that particular patient. An understanding of the aspects of each individual’s medical and physical examination is needed to modify the care based on those findings. The presentation of an overweight patient should lead the clinician to consider specific medical issues.

Patients that are overweight are further subclassified into the categories of overweight, obese and morbidly obese. Although some of these patients can be treated “conventionally” in the office further evaluation of their particular medical status is indicated.

Overweight patients will have a compromised airway and the establishment of an emergent airway can be severely compromised. A neck circumference of greater than 17 inches is also associated with a high rate of obstructive sleep apnea. Respiratory function will be further compromised in a supine position, consistent with a restrictive lung disease.

Other co-morbid diseases in the obese patient can lead to poor outcomes. The potential for diabetes mellitus along with a decreased lower esophageal sphincter tone can lead to aspiration during sedation and anesthesia.

In conclusion, although obesity is not a specific contraindication for an office anesthetic the surgeon needs to expect a patient that is not as healthy as they may seem. Expectations of decreased respiratory and cardiac function may further compromise the patient and treatment of the moderate to severely obese patient should warrant modifications to the usual anesthetic and surgical treatment plan.