Updated ESA guidelines for pre-operative evaluation in Obesity

European Society of Anaesthesiology (ESA) has released its latest recommendations on the preoperative evaluation of the adult undergoing noncardiac surgery. The present guidelines are an update of 2011 European Society of Anaesthesiology (ESA). The purpose of the guidelines is to present recommendations based on the available relevant clinical evidence. Due to the lack of well-performed randomized studies on the topic, many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries.

For the present revision of the guidelines, ESA formed a task force comprising of members of the previous task force, ESA scientific subcommittees and volunteers from ESA and national societies who selected relevant systematic reviews with meta-analyses, randomized controlled trials, cohort studies, case-control studies and cross-sectional surveys from different electronic databases. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations.

The present guidelines are an update of 2011 European Society of Anaesthesiology (ESA) recommendations on the pre-operative evaluation of t

The prevalence of obesity in developed countries has increased significantly in recent decades. Obesity has major implications for the anesthesiologist due to the associated changes in cardiovascular, pulmonary and gastrointestinal physiology. The obese are at an increased risk from procedures such as endotracheal intubation and positioning. Strategies are needed to reduce peri-operative risks and to enable well-tolerated anesthesia.

Given below are some Key Recommendations for pre-operation evaluation of patients with obesity-

• Pre-operative assessment of the obese should at least include the STOP-BANG questionnaire, clinical evaluation, ECG, oximetry and/or polysomnography


• Laboratory tests should be performed for detection of pathological glucose/HbA1c concentrations and anemia in the obese


• Neck circumferences at least 43 cm, as well as a high Mallampati score, are predictors for a difficult intubation in the obese


• Use CPAP/PSV/BiPAP peri-operatively might reduce hypoxic events in the obese

For further information click on the link: 10.1097/EJA.0000000000000817