might not be suitable for undergoing surgery in an outpatient setting.
Of course, the majority of high-BMI patients are candidates for
same-day surgery, as long as your facility knows how to properly man-
age their care during all phases of the surgical episode. Everyone
involved in the procedure — surgeons, anesthesiologists, administra-
tion and nursing staff — must collaborate to create guidelines for han-
dling high BMI patients. "You never want to call them rules," says Dr.
Sinha. "You call them guidelines because you have the ability to be
discretionary."
Your facility's guidelines should include understanding and manag-
ing the clinical challenges of caring for obese patients.
• Difficult airways. While patients with high — even extremely high
— BMIs can successfully undergo most outpatient procedures,
"Airways are always a
big concern," says Ms.
Pate. "Managing the
airway is a major part
of our educational
efforts."
Obesity increases
the difficulties of mask
ventilation and intuba-
tion. The challenge is
that high-BMI individu-
als generally have a
high metabolic
demand, and their oxy-
gen reserves are low.
"The scales are swing-
ing in the wrong direc-
3 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 9
