Jonathan Mark Cousins

Imperial College Healthcare NHS Trust · Division of Anaesthesia Critical Care and Theatres

This leaflet explains why and how additional body weight can cause added difficulties and risks during surgery and anaesthesia. It also highlights what can be done before, during and after surgery to reduce these risks.

Background Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morb...

In June 2020, the journal Anaesthesia published an editorial about the potential problem of inadvertently ‘fat shaming’ patients with obesity when discussing the legally-obliged risks related to anaesthesia [1]. Naturally this article caught the attention of our Society (SOBA); we responded to the journal stating that we were keen to contribute tow...

The key or core issues in obesity anaesthesia with reference also to bariatric surgical and peri-operative concerns.

Background Obesity confers higher risks of atrial arrhythmias and sudden cardiac death. Despite this, the proarrhythmic substrate in obesity and its reversibility with weight loss has not been studied in-depth. To address this, the proarrhythmic substrate in obese patients, and its reversibility with bariatric surgery, was characterised using elect...

Background After the declaration of COVID-19 as a pandemic last March 2020, several adjustments in surgical services were implemented. Plans are now being formulated for restarting bariatric surgery. The aim of this survey is to capture the practice during the pandemic and the readiness to restart to provide a framework to deal with the backlog of...

Objective: The aim of this study was to examine the clinical efficacy and safety of the duodenal-jejunal bypass liner (DJBL) while in situ for 12 months and for 12 months after explantation. Summary Background Data: This is the largest randomized controlled trial (RCT) of the DJBL, a medical device used for the treatment of people with type 2 diab...

An overview of the reasons for critical care use after anaesthesia and surgery for obese patients. Using the latest available data from around the world and using bariatric surgery as a guide, the chapter discusses the wider implications of obese patients requiring higher levels of critical care.

The letter supports the authors of the review and agrees with the need for improved guidance and organisational preparedness in this field Dear Editor, SOBA UK read this article with interest and welcome the review of managing patients with obesity in the emergency setting [1]. Many of the practical issues highlighted are common to non-emergent pra...

Background Post-operative pain management following laparoscopic bariatric surgery can be challenging. There are concerns regarding the use of opioids. The rate of cardiorespiratory problems following neuraxial opioids is unclear. There is little published data on their use in bariatric surgery. This study aimed to assess technique feasibility, pai...

Background There is significant pulmonary functional deficit related to obesity, but no prospective CT studies have evaluated the effects of obesity on the lungs and trachea. Purpose To evaluate lung parenchymal and tracheal CT morphology before and 6 months after bariatric surgery, with functional and symptomatic correlation. Materials and Methods...

Methods References Conclusions This survey suggests there are a wide variety of areas considered priorities for airway-related research in the morbidly obese. HFNO and pre-oxygenation are popular topics across experience categories, the applications of ultrasound rate as least important, but there is little consensus in between. Although limited by...

Background Obesity surgery has pronounced effects on metabolic profile of patients with type 2 diabetes mellitus (T2DM); however, reports on long-term remission rates based on the standardised and holistic criteria by the International Diabetes Federation (IDF) and effects on T2DM microvascular complications are scarce in the literature. In this re...

Introduction The Apollo OverStitch is a minimally invasive endoscopic suturing device which allows full thickness suturing without the need for surgeryRoux-en-Y gastric bypass (RYGB) can achieve up to 60% weight loss 2 years after surgery but 30% of patients will regain their weight within 2 years. The options for this group of patients are limited...

A snapshot of current practice amongst UK bariatric anaesthetists

The prevalence of obesity in the UK is increasing. Airway management in the obese patient can be challenging. Face mask ventilation is frequently difficult, and while the incidence of difficult laryngoscopy is only marginally raised, the consequences of failed intubation and the rate at which the obese patient desaturates makes this an unforgiving...

Introduction: The use of intrathecal diamorphine is not commonplace in laparoscopic bariatric surgery. At our institution, a major UK bariatric centre, high-dose intrathecal diamorphine is routinely utilised. Methods: Data were analysed retrospectively. Fifty-three patients who had a spinal anaesthetic were matched against age, sex, body mass in...

Cambridge Core - Anesthesia, Intensive Care, Pain Management - Core Topics in Anaesthesia and Perioperative Care of the Morbidly Obese Surgical Patient - edited by Christopher Bouch

This national survey has highlighted areas of common practice and differences amongst those who regularly anaesthetise patients for weight loss surgery. Some members said they do not practice particular techniques due to the unavailability or restrictions on the use of drugs or equipment (e.g. Optiflow, Sugammadex). We expect the THRIVE technique t...

Purpose of review: With the prevalence of obesity rapidly growing, bariatric anaesthesia becomes everyday anaesthesia rather than a subspecialty. In this review, we are aiming to draw attention to this complex group of patients and their comorbidities, relevant to everyday practice for contemporary anaesthetists. Recent findings: We wanted to fo...

Aim: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI). Methods: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdo...

Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion. © 2015 The Association of Anaes...

The use of inferior vena cava (IVC) filters for prevention of venous thromboembolism (VTE) in bariatric surgery is a contentious issue. We aim to review the evidence for the use of IVC filters in bariatric surgical patients, describe trends in practice, and discuss challenges in developing evidence-based guidelines. The incidence of VTE in modern b...

Obesity is an important modifiable risk factor for musculoskeletal disease. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of bariatric surgery on musculoskeletal disease symptoms was performed. One thousand nineteen papers were identified, of which 43 were eligible for data synthesis. Ther...

Introduction: Laparoscopic Roux-en-Y gastric bypass has become one of the most common techniques for surgical treatment of morbid obesity.1 Over the past decade, robot-assisted procedures for abdominal surgery have increased.2,3 Robotic surgery seemed to be the recuperation of the third dimension with the advantages of the laparoscopic surgery.1,4...

Aims The aim of the study was to examine ventricular remodelling in patients free of cardiac risk factors, before, and 6 months post-bariatric surgery with the new imaging modality of three-dimensional (3D) strain and the comparison of two surgical techniques: sleeve gastrectomy vs. gastric bypass. Methods and results Fifty-two consecutive patient...

Bariatric surgery for obesity remains the most effective method to achieve weight loss and improvements in mortality. However, as the number of procedures increases to match the rising burden of obesity, unusual metabolic complications are now coming to the fore. One example of this is postprandial hypoglycaemia (PPH). The incidence of PPH has been...

There is paucity of data on Enhanced Recovery After Bariatric Surgery (ERABS) protocols. This feasibility study reports outcomes of this protocol utilized within a tertiary-referral bariatric centre. Data on consecutive primary procedures (laparoscopic gastric bypasses, sleeve gastrectomies and gastric bands) performed over 9 months within an ERABS...

Obesity is the new epidemic and is associated with an increased risk of diastolic and systolic heart failure. Effective treatment options with drastic results such as bariatric surgery have raised interest in the possible reversal of some of the cardiovascular sequelae. Many studies have assessed individually the effect of weight loss on specific e...

Aim: The aim of the study was to examine ventricular remodeling in a group of patients free of cardiac risk factors, before and 6 months post bariatric surgery with the new imaging modality of 3-dimensional strain and compare two surgical techniques: sleeve gastrectomy vs. gastric by-pass. Methods: Fifty-two consecutive patients who were referred...

Purpose: The aim of this study was to examine left ventricular (LV) echocardiographic indices, 4D volumes and ejection fraction of bariatric patients (BMI > 40). Methods: Forty-nine consecutive normotensive bariatric patients (31 women (63.2%), 43 Caucasian, mean age: 45.7 ± 9.7 years, BMI ≥ 40 kg/m2) were examined with 3D and speckle tracking ech...

Purpose: We hypothesize that the right ventricle (RV) will be the first chamber to remodel in obesity and to demonstrate signs of early diastolic filling impairment. Therefore, RV echocardiographic indices, 4D volumes and strain of bariatric patients were compared to 30 age-matched healthy volunteers. Methods: All patients had a body mass index >...

Export Date: 17 June 2013, Source: Scopus

The aim of this article is to present the features of chronic renal disease (CRD) that influence the conduct of anaesthesia and to introduce some of the anaesthetic techniques used for this challenging group of patients, including anaesthesia for renal transplantation.

Anaesthesia for urological surgery poses particular challenges for the anaesthetist related to the patient population and procedure type. The aim of this article is to cover the general principles of anaesthesia, with dedicated sections relevant to practising urological surgeons. This represents vast amounts of knowledge that cannot be covered in o...

This commentary represents a selective survey of developments relevant to critical care. Selected themes include advances in point-of-care diagnostic testing, glucose control, novel microbiological diagnostics and infection control measures, and developments in information technology that have implications for intensive care. The latter encompasses...