complications with
obese patients, says
Mr. Ruspantine:
• NPO is a must.
Obese patients
must adhere to
this rule for at
least 12 hours.
• Avoid general
anesthesia when
possible, and use
safety measures if patients must be intubated.
• Try to avoid narcotics; use NSAIDs or intravenous acetaminophen
before induction.
• Administer antiemetic medication, such as a scopolamine patch
applied the morning of surgery, to prevent aspiration, and use an
antiemetic medication regime that includes ondansetron, decadron,
and, if necessary, metoclopramide.
• Adequately pre-oxygenate to compensate for potential rapid desat-
uration.
• Avoid deep Trendelenburg positioning.
• Always use capnography monitoring.
2. Sleep apnea
The potential for obstructive sleep apnea is another crucial considera-
tion in regard to the anesthetic care of obese patients. But, says Mr.
Ruspantine, some patients with mild sleep apnea or STOP BANG
(osmag.net/dtwzf5) scores above 3 can successfully undergo most outpa-
tient procedures, using local with sedation, regional or general anes-
thesia (potentially without intubation) and minimal narcotics.
M A Y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 1 0 3
• SETTLED SCIENCE A well-planned multimodal approach can virtually eliminate incidents of PONV.
Pamela
Bevelhymer,
RN,
BSN
