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Minerva Anestesiologica 2016 December;82(12):1314-35


language: English

Perioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI Consensus

Flavia PETRINI 1, Ida DI GIACINTO 2 , Rita CATALDO 3, Clelia ESPOSITO 4, Vittorio PAVONI 5, Paolo DONATO 6, Antonella TROLIO 7, Guido MERLI 8, 9, Massimiliano SORBELLO 10, 11, Paolo PELOSI 12, on behalf of Obesity Task Force for the SIAARTI Airway Management Study Group 

1 Department of Perioperative Medicine, Pain Therapy, Rapid Response Systems and Intensive Care, DEA, University of Chieti-Pescara, ASL2 Abruzzo, Chieti, Italy; 2 Anesthesia, Polyvalent Intensive Care and Transplantation Unit, Department of Organ Failure and Transplantation, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University, Bologna, Italy; 3 Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy; 4 Department of Anesthesia and Postoperative Intensive Care, Ospedali dei Colli, Monaldi Hospitals, Naples, Italy; 5 Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care, Santa Maria Nuova Hospital, Florence, Italy; 6 Intensive Care Unit, Department of Anesthesia, Maggiore della Carità University Hospital, Novara, Italy; 7 Anesthesia and Critical Care Medicine Unit, Department of Perioperative Medicine, Pain Therapy, Rapid Response Systems and Intensive Care, DEA, University of Chieti-Pescara, ASL2 Abruzzo, Vasto, Italy; 8 Department of Anesthesia and Intensive Care Unit, Maggiore Hospital, Crema, Italy; 9 Past Chair of the SIAARTI Airway Management Study Group; 10 Anesthesia and Intensive Care Unit, AOU Policlinico Vittorio Emanuele University Hospital, Catania, Italy; 11 Present Chair of the SIAARTI Airway Management Study Group; 12 Department of Surgical Sciences and Integrated Diagnostics, Anesthesia and Intensive Care, San Martino University Hospital and Institute for Research and Care, IRCCS, University of Genoa, Genoa, Italy

Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose Body Mass Index (BMI) is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population. Obesity is a multisystem, chronic, proinflammatory disorder. Unfortunately many countries are facing a marked increase in the obese population, defined as “globesity”. Obesity presents an added risk in hospital, leading health care organizations to call for action to avoid adverse events and preventable complications. Periprocedural assessment and critical care strategies designed specifically for obese patients are crucial for reducing morbidity and mortality during surgery and in emergency settings, critical care and other particular settings (e.g., obstetrics). Specific care is needed for airway management, as are proactive strategies to reduce the risk of cardiovascular, endocrine, metabolic and infective complications; any effort can be fruitful, including special attention to the science of human factors. The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving other national scientific societies to increase risk awareness, define the best multidisciplinary approach for treating obese patients in election and emergency, and enable every hospital to provide appropriate levels of care and good clinical practices. The Obesity Project Task Force, a section of the SIAARTI Airway Management Study Group, used a formal consensus process to identify a series of notes, alerts and statements, to be adopted as bundles, to define appropriate clinical pathways for hospitalized obese patients. The consensus, approved by the Task Force and endorsed by several European scientific societies actively operating in this field, is presented herein.

KEY WORDS: Obesity - Perioperative care - Critical care - Patient safety - Clinical pathways

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