says Perry V.
Ruspantine,
CRNA, APRN,
clinical compli-
ance manager
for Anesthesia
Professionals in
Dartmouth,
Mass. Due dili-
gence and prop-
er screening are
the keys. While
difficult airways are common in obese patients, BMI shouldn't be the
lone determining factor when deciding whether to treat them, says
Mr. Ruspantine. Other considerations may be just as important, he
says, including a patient's Mallampati score and neck circumference.
A Mallampati score of 3 or 4 may indicate potential difficulty, as can a
neck circumference of more than 40 cm. And as circumference
increases, so does the risk. Additionally, a thyromental distance (the
distance between the thyroid notch and the mentum) of less than 6
cm suggests potential difficulty.
Ideally, you'd have patients lose the extra weight before surgery. But
this is especially difficult in outpatient settings and it's rare, no matter
how much time elapses between scheduling and procedure.
In any event, planning ahead is crucial. "The incidence of difficult
intubation in obese patients has been reported to be between 13% and
24%," says Mr. Ruspantine. "Make sure obese patients have pre-anes-
thetic interviews well in advance of the anticipated surgery. You need
to have enough time for an assessment and care plan."
Obese patients also often have tough-to-access veins. You must
1 0 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 6
• WEIGHING CONCERNS BMI is just one of several factors to consider when deciding whether to treat obese
patients in outpatient settings.
Pamela
Bevelhymer,
RN,
BSN
