Positioning the Bariatric Patient in the OR
Positioning the bariatric patient to prepare to undergo surgical intervention is an important step in preventing complications in the perioperative period. An interprofessional unit is required with the combined efforts of the physician, the surgical nurs
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Neha Patel and Elton Taylor
10.1 Goals of Positioning Positioning the bariatric patient to prepare to undergo surgical intervention is an important step in preventing complications in the perioperative period. An interprofessional unit is required with the combined efforts of the physician, the surgical nursing staff, and the anesthesia staff to prepare for an uneventful procedure [1, 2]. Patient immobility is a risk factor for complications and more so in the bariatric patient. Comfort and safety with prevention of injuries are the basis for some of the positioning tactics which will be discussed. Maintaining airway and circulation and exposure of operative site also need to be taken into account when positioning the bariatric patient for continued care throughout the case.
10.2 Airway Challenges (Risk of Aspiration) There are many challenges with regard to the anesthesia management of the bariatric patient. Excess tissue over the neck, chest, and fat pads in the oral pharynx can make access difficult. Partial airway obstruction secondary to this extra fat also leads to more difficulty with vocal cord visualization. Extra weight on the neck and chest can also lead to obstructive sleep apnea (OSA) with resulting increased rate of oxygen desaturation. Oxygenation is important for preoxygenation prior to intubation. Adequate oxygenation allows for enough time to carefully intubate the patient. Extra weight and increased gastric pressure also increase aspiration risk, and there is increased risk of damage with aspiration. One way to prevent this is to give histamine antagonists preoperatively as well as insisting a fasting state is started at midnight, the night before the procedure [3].
N. Patel, DO (*) • E. Taylor, DO, MBA Department of General Surgery, Rowan University, Stratford, NJ, USA e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2017 A. Loveitt et al. (eds.), Passing the Certified Bariatric Nurses Exam, DOI 10.1007/978-3-319-41703-5_10
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N. Patel and E. Taylor
10.3 Cardiac/Vascular/Other Challenges In obese patients there is increased cardiac stress at baseline from the additional body weight. There is also increased pressure on the inferior vena cava [2]. This combination can impede circulation and alter hemodynamics making it crucial that they are closely monitored during the procedure. Patients are more susceptible to increased or decreased heart rate, slowed conduction, and ischemia. Extra chest fat and tissue can also impede ECG tracing to accurately monitor the patient’s rhythm [2]. Obesity, as well as the reverse Trendelenburg position (feet down), also puts patients at an increased risk for deep venous thromboses (DVTs). There is increased pressure on dependent surfaces and, in this position, the legs, increasing the risk of DVT in the legs [4]. It is extremely important that the thromboembolic device stockings are placed correctly with the stockings fitting appropriately, as to not cause a tourniquet effect, and that the stocking is smooth
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