known or presumed obstructive sleep apnea (OSA) follow the Society
for Ambulatory Anesthesia (SAMBA) OSA guidelines, and that patients
with a BMI of 50 or greater are not suitable for surgery
(osmag.net/U6AqaM).
2. Weighing comorbidities
Pre-op examinations sometimes lead to disagreements among sur-
geons, anesthesiologists and nurses about whether it's safe to operate.
"Let's say you're an orthopedic surgeon, and you bring in a patient
who weighs 300 pounds," says Ashish C. Sinha, MD, PhD, DABA,
MBA, professor and vice chairman of the department of anesthesiolo-
gy at Temple University Lewis Katz School of Medicine in
Philadelphia, Pa. "And you tell your team that, 'Hey, this is our first
guest for the day.' And the team goes, 'Wait a minute, this patient's 300
pounds, we can't do this at an outpatient surgery center.' And the sur-
geon goes, 'Why not?' And the team says, 'Because it's risky.' And he
says, 'Well, why is it risky? Last week, we did somebody who was 295
pounds, and we didn't have any problems. How is this patient actually
different other than the 5-pound weight increase?' That's a very hard
argument to counter."
Explicit policies and procedures can help eliminate these arguments,
but, again, there are no standards to reference. The American Society of
Anesthesiologists and American Association of Nurse Anesthetists
haven't set hard guidelines for these situations, but they point to recom-
mendations that center on comorbidities rather than weight.
"I could be a 250-pound person, and you could be a 300-pound per-
son, and you could be healthier than me," says Dr. Sinha. "You could
be an NFL player, for example. So weight cannot be the be-all and end-
all for drawing a line in the sand."
Obese patients indeed have an increased likelihood of comorbidities
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