By: Vipul Shah, MD, and Stephanie B. Jones, MD
Whether this is your first or your fifth operation, going under anesthesia can be an anxiety provoking experience. As anesthesiologists, patients often ask us: “How will you know if I am getting enough anesthesia?” or “Will I feel pain?” While nothing in life is completely free of risk, advances in technology and monitoring have made “going under” much safer than it was in the past. Your anesthesiologist is trained to look for signs that you are adequately anesthetized during surgery, and we have many medications to help alleviate pain.
If you are an individual with obesity, you may have heard rumors that can make you even more apprehensive about anesthesia. The good news is that anesthesia is still safe for people with obesity, although there are special considerations that are specific to this population. Along with all the standard preparations, such as determining which medications to stop and which to continue to take up to the day of surgery, individuals with obesity often have other health conditions that can play an important part in how well they do during and after the operation.
Individuals with obesity are at a higher risk for diabetes.¹ If you have diabetes, it is important to continue to be vigilant about blood sugar control as uncontrolled diabetes can complicate surgery and recovery. Even if your diabetes is well controlled, your drug regimen may need to be adjusted prior to going to the operating room. If you are taking insulin, a general rule is to take half your normal dose of long-acting insulin the night before surgery because you will not be eating after midnight the day of your operation. The exact details are tailored to each individual and you should discuss your diabetic management with your primary care physician (PCP) prior to surgery. Individual with obesity also have a higher risk of obstructive sleep apnea (OSA). If you have OSA, it is important to use your continuous positive airway pressure (CPAP) machine as prescribed. If you think you may have OSA but have not been diagnosed, discuss your options with your PCP.
Now comes the big day. The anesthesiologist will tailor the type of anesthetic to best suit the needs of you and your surgeon. The anesthesiologist may offer deep sedation, general anesthesia, and/or a nerve block. He or she may also recommend different monitoring devices to help keep you safe during the procedure. Regardless of the type of anesthesia, there are specific challenges for you and your anesthesiologist if you have obesity. Procedures such as intravenous (IV) placement, nerve blocks, and epidurals may be more difficult because in individuals with obesity it can be difficult to locate the anatomical structures (e.g., veins) needed to complete the task. The best advice for you is to be patient, and if you are getting uncomfortable, ask for a break. Your anesthesiologist wants to make sure you are at ease before surgery, so he or she will usually be willing to give you time to catch your breath if a procedure is difficult.
If you are going to be under general anesthesia, there is an increased risk of difficulty with placement of a breathing tube. Most hospitals have several different devices that can help with the placement of breathing tubes, but if you have ever been told that you are a “difficult intubation,” it is extremely important to tell your anesthesiologist and surgeon prior to the surgery. You may be asked to take an antacid prior to surgery. Since individuals with obesity may have a higher risk of aspiration (inhalation of stomach contents) during intubation, this will neutralize stomach acid. Another good practice is to bring your CPAP machine with you when you come to the hospital. If you are going to be under sedation, your anesthesiologist may have you use it during the operation, and it is important to use it after surgery when you are waking up from anesthesia.
Once the operation is over, there are still some important considerations. Your anesthesiologist and surgeon will want to maximize your breathing capacity because during the time spent under anesthesia, the lungs can become compressed. In order to do this, you may use a device called an incentive spirometer to help expand your lungs. If you are still in significant pain, your anesthesiologist may recommend other techniques to combat your pain, such as nerve blocks or epidurals, in order to decrease the need for sedating pain medications. Finally, there is an increased risk of developing a blood clot, so you will likely receive bloodthinning shots and be encouraged to get out of bed as soon as possible.
As you can see, going under anesthesia can be safe, as long as you are aware of the risks and work with your doctors to try to minimize risk impact. If you have any specific questions or concerns, you should contact your anesthesiologist before the day of surgery to address them so you can be confident and feel safe on the day of surgery.
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