NCEPOD Implications for Anaesthesia Dr Jonathan Cousins FRCA
NCEPOD Implications for Anaesthesia Dr Jonathan Cousins FRCA FFICM Vice-Chairman of SOBA Society for Obesity and Bariatric Anaesthesia UK Anaesthetic aspects of bariatric surgery Impact of this report on anaesthesia SOBA
Who are we Why are here When do we meet We do.. Anaesthesia
Obesity widespread ? Nuisance Traditional teaching in context BMI 49 BMI 57 = 17 Stone extra Obesity and mortality Young BMI>45 Age 14 20 30
40 50 YEARS OF LIFE LOST 12 10 8 BMI 36 6 4
Source: Years of life lost due to obesity. JAMA 2003;289:187. 45 44 43 42 41 40 39
38 37 36 35 34 33 32
31 30 29 28 27 26 0 25
2 BMI Risks or Comorbidities Causes1 2
1 1 Risks Centre (team3) OS-MRS2 IHD Respiratory DM OSA Clotting DeMaria EJ et al. Ann Surg, 2007
Risks: BMI>50 Age>45 BP Male DVT/PE/OSA 3 Courcourlas , Schubert Obesity Surg 2003 Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery N Engl J Med 2009 Score: 0-1 = 0.2%
2-3 = 1.1% 4-5 = 2.4% MDT 45% Cases were reviewed Who else was ---- missing ?? Bariatric Physicians ! Psychiatric Support ! WhatCANwe bring to the MDT ?
Investigations CT/MRI Screening for OSA Cardiac opinions Parity with the USA ? Investment in facilities SOBA recommends Pre-Anaesthetic Assessment Clinic
Most went to PAAC Only 68% didnt see anaesthesia 19% assessments were inadequate ASA no link to PAAC use ASA and OS-MRS SOBA recommends Why not ?
Only 3 % had problems Airway and low blood pressure Appropriate equipment Well monitored throughout nb NAP4 + SOBA Critical Care
28% elective use of L2/3 beds 2.8% unexpected usage Split private and NHS provision NCEPOD recommends policy SOBA supports IHAS 1 and policy 1 IHAS-Clinical Guidelines for the establishment of a bariatric service Oct 2012 After surgery 70% go to ward beds Tracking was poor Care was poor in 10%
Experience Misdiagnosis Anaesthesia Summary Safe High Standards seen As surgical field progresses Unit evolution is needed SOBA Recommendations
MDT onwards involvement High risk case review essential Post-Op care to be improved IHAS guidance Sensible experience
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