Monday, February 16, 2009
In Before the Scalpel: What Everyone Should Know about Anesthesia, Dr. Dhar walks readers through the various steps that ensure a safe and pain-free experience during medical procedures that may require or benefit from anesthesia. Before the Scalpel is formatted and illustrated for quick and easy reference in an interactive manner. This is a take-along-book to the doctor’s office, with outlines and room to make notations. Each chapter is a mini crash course for any person who is concerned about the anesthesia aspect of surgery.
In Before the Scalpel: What Everyone Should Know about Anesthesia, Dr. Dhar explores such real-life topics as:
• Pain-relief options during Labor and Delivery
• Facts to know before deciding on Plastic and Cosmetic Surgery
• Why children are not just “small adults” when it comes to anesthesia
• How obesity adds risk to surgery and anesthesia
• The common fear of awareness during anesthesia
Author Panchali Dhar, MD, is an Assistant Professor of Clinical Anesthesiology and Anesthesiologist at New York-Presbyterian Hospital/Weill Cornell Medical Center and is board-certified in Internal Medicine and Anesthesiology. She has demystified the process and terms associated with anesthesia and arranged the information in an easy to understand topic-by-topic sourcebook. Dr. Dhar takes you into the complicated, fascinating, cutting-edge world of anesthesia.
To learn more about Before the Scalpel: What Everyone Should Know About Anesthesia visit Tell Me Press at www.tellmepress.com
For today, I have asked Dr. Dhar to put together an article on the topic of how obesity adds risk to surgery and anesthesia. Here's what she had to say:
Obesity is a world wide epidemic. Obese patients have problems as a direct result of their obesity--such as knee pain and lower back pain, heart disease and diabetes. They also have a greater chance for going for various surgeries like hernia repairs. A number of new doors have opened in the world of anesthesia to help the obese patient.
Technical difficulties: The weight itself presents a challenge for the patient, doctors and nurses. Moving the patient on and off an operating table usually involves several strong people. Many health care workers have injured their own backs moving 300, 400, 500 pound persons. Special lifts have been created for moving such heavy patients. Sometimes, a wider operating table can be used to accommodate the patients. Then there is the problem of tucking the arms along the side of the patient so the surgeon can comfortably operate and reach over. Specially designed arm rests and layers of foam are used to pad the arms. Proper padding is the responsibility of an anesthesiologist.
It may take longer for the anesthesiologist to find a vein on the arm or hand because layers of fat obscure the "blue" color of veins. Not uncommonly do obese patients receive multiple needle sticks for blood draws and intravenous line insertions. Good thing anesthesiologists are the hospital experts at blood draws and intravenous line placements.
Medical advancement: Every piece of equipment is upsized for the obese patient. A routine device such as a blood pressure cuff that wraps around your upper arm is made larger and wider. Specially designed pillows or multiple pillows are used to help obese patients lay "flat". Most patients with morbid obesity cannot lay flat because their abdominal organs push up on their lungs, and they have difficulty breathing. More pillows raise the head.
Anesthetic techniques can accommodate the obese patient. General anesthesia has certain inherent risks for the obese. A breathing tube has to be placed in the windpipe as soon as general anesthesia is started to maintain oxygen levels and continue the anesthesia. The anesthesiologist today has an array of tools, scopes and camera gear to put the breathing tube in quickly. This is where anesthetic skill comes into play.
A regional anesthetic (nerve blocks, spinal, and epidural) may be an option to avoid the breathing tube placement I just described. Nerve blocks target specific nerves in the area of surgery to numb the site and prevent movement. Such nerve blocks are now done with ultrasound guidance. This machine provides a picture on a screen for locating the target nerves. Many anesthesiologists are specially trained in regional anesthesia. In addition, extra long spinal and epidural needles have been created for the obese. Specially designed needle length helps the anesthesiologist to go through inches of fat before getting near the proper location.
Additional Issues: Obese patients may need to be on a ventilator for a short while after surgery because they may not have the strength to breath on their own after a long surgery. Plus, there is increasing evidence that obese patients have a higher incidence of infections at the site of surgery.
For more information on concerns for overweight patients, please watch this video: