Obesity and Anesthesia – Weight Limit

Transcript

Let’s talk first about how obesity is diagnosed and defined. The diagnosis of obesity is often based on body mass index, BMI, calculated as weight in kilograms, divided by height in meters squared. BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9, overweight, and a BMI of greater than 30 is considered obese. Obesity is further categorized into class one, BMI of 30 to 34.9; class two, BMI of 35 to 39.9; and class three, BMI of greater than 40. BMI does not account for the regional distribution of adipose tissue, factors which can have an important implication for clinical assessment of patient. There is no weight limit for surgery, per se. If one needs life-saving surgery, surgery will be done independently of a patient’s weight. However, being obese or morbidly obese increases the risk for complications from anesthesia and surgery alike, especially in an emergent situation. If an obese or morbidly obese patient is scheduled for elective surgery in the hospital, depending on the patient’s underlying medical problems, the patient might be asked to lose some weight first and / or be optimized as much as possible prior to surgery. In an outpatient setting, for example a freestanding surgery center, weight limitations are in place for patient safety. Usually anyone above a BMI of 50 will not be scheduled in this setting, and a BMI between 45 and 50 will usually require the patient to be evaluated by the center’s anesthesiologist prior to the day of the procedure to determine if it’s safe to have to procedure done. Weight distribution and underlying comorbidities, among other factors, will be evaluated during this pre-procedure visit to determine if it’s safe to proceed in an outpatient setting.