BARIATRIC SURGERY
anaesthetic bariatric fellow at Homerton University Hospital, and Dr Lauren Barraclough, have been investigating this as part of the ‘Bariatric Issues during General Anaesthesia related to Airway (BIGGA) project.5 Supported by the trainee-led Pan London Audit Network (PLAN), the project is being rolled out throughout 2018 and aims to answer the following questions: n What proportion of elective surgery is carried out on overweight or obese patients?
n Are anaesthetics being modified, and appropriate equipment made available, for obese patients?
n Are modifications leading to a reduction in airway problems?
Some preliminary data has been gathered and the findings suggest that there is a need to provide further training on the available best practice guidelines. “We wanted to gather some baseline data, prior to the launch of the project, to establish the level of awareness of the guidelines with our colleagues,” Dr Black explained. “Had they ever heard of them? Did they use them in their practice? We sent out a simple multiple- choice questionnaire to anaesthetists of all grades to local hospitals. “Around 85 anaesthetists responded to the survey. Looking at basic WHO [obesity] definitions, most people were able to identify patients that were obese or overweight, based on their BMI, but around a fifth of anaesthetists were unclear about the definitions and it wasn’t the trainees that were getting this wrong,” she commented. “Over 50% of respondents had never heard of the SOBA/AAGBI guidelines. Of those who had, only 20% had actually read it for themselves. Most surprising, was the fact that 60% had never heard of the SOBA sheet, which is just a single page. Only 10% of respondents used it in their workplace.” The majority of respondents had
heard of the NAP4 audit but there was confusion regarding the origin of newer bariatric guidelines: 32% did not know there were obesity specific recommendations within NAP4; 33%
were unaware there are specific guidelines for anaesthetising obese patients; and most people had not read, nor received teaching on AAGBI/SOBA guidelines. “This survey suggests that there is poor knowledge of the guidelines in circulation, but we don’t know what this means. What is the outcome on clinical practice?” commented Dr Black. She explained that the BIGGA project will go on to evaluate: are anaesthetics being modified and appropriate equipment being made available for obese patients? Are modifications leading to a reduction in airway problems?
Conclusion Staff practicing in theatres, and beyond, need to improve their knowledge of how to effectively manage obese patients, to ensure their safety during the perioperative and recovery period. With increasing numbers of obese patients presenting in theatres, hospital Trusts need to be prepared, properly equipped and staff need to be familiar with the latest guidance. There is evidence to suggest there is a need to provide access to specialist training and to raise awareness – at all levels. However, the results of the BIGGA project will provide further insight into the scale of the issue and prompt further dialogue on how hospitals could drive improvement in the future.
Hospital management need to be aware of the additional time and resources needed to safely anaesthetise obese patients.
28 l JULY 2018 l OPERATING THEATRE References
1 Statistics published by NHS Digital, April 2018. 2
Association of Anaesthetists of Great Britain and Ireland and Society for Obesity and Bariatric Anaesthesia. Peri-operative management of the obese surgical patient 2015. Anaesthesia 2015, 70, pages 859–876.
www.aagbi.org/sites/ default/files/Peri_operative_management_ obese_patientWEB.pdf
3 SOBA Single Sheet,
www.sobauk.co.uk/ downloads/single-sheet-guideline
4 Dr Mike Margarson and Prof Mark Bellamy, Designing intelligent anaesthesia for a changing patient demographic: A consensus statement to provide guidance for specialist and non-specialist anaesthetists written by members of and endorsed by the Society for Obesity and Bariatric Anaesthesia (SOBA).
www.sobauk.co.uk/downloads/core-issues
5
J. J. Pandit et al, 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors BJA: British Journal of Anaesthesia, Volume 113, Issue 4, 1 October 2014, Pages 549–559,
https://doi.org/10.1093/bja/aeu313
6 NICE, Depth of anaesthesia monitors – Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M, November 2012,
https://www.nice.org.uk/ guidance/dg6/chapter/1-Recommendations
n
7 Major complications of airway management in the UK: results of the 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1 Anaesthesia. British Journal of Anaesthesia. doi:10.1093/ bja/aer058; and Major complications of airway management in the UK: results of the 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2 Intensive Care and Emergency Departments. British Journal of Anaesthesia. doi:10.1093/bja/aer059
http://www.rcoa.ac.uk/nap4
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