Most ambulatory facilities will not take patients with a BMI above
40, which I think is the safest approach. Some have gone as high as
50, which is on the razor's edge. Someone with a BMI of 55 might
have a perfectly fine airway, but they still have a BMI of 55 and all the
potential complications that come with it.
Build relationships based on mutual respect. Some surgeons
will adopt the attitude of, "This is my patient," and they believe
that whatever they say goes. But as an anesthesia provider, it's your
patient, too, and you have a duty and a responsibility to that patient.
You must have the confidence to know the difference between keep-
ing the peace with an overeager surgeon and veering into territory
that could endanger the patient. After all, if there's an injury, and your
action or inaction is determined to be the proximate cause, it's your
license on the line.
Stay away from "cowboys." Safety starts with having the right
people on your team. If you need to staff a case with an anesthe-
sia provider, don't just take the first body that comes in the door. Avoid
anyone who is cavalier about the way they practice — "cowboys," as I
call them. They're overconfident, even cocky, and they're the ones who
scare me the most.
We have a very strict code about patients: Treat everyone as if she is
your mother. If you do that from the very beginning, it keeps you hon-
est and it prevents you from stepping into territory where you should-
n't be. I don't want anyone in the OR who doesn't share that mentality.
Make sure you have a robust vetting process. Anesthesia is a small
community, so it's easy to make a phone call and find out if a provider
would be a good fit for your team.
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