Overview

European statistics on obesity

The growth of obesity rates among adults is a major public health concern. Across the European Union, 15,5% of the adult population are obese1. The rate of adult obesity has more than doubled in the past 20 years in most of the EU countries2

Challenge

Obesity is a known risk factor for numerous health problems, including hypertension, cardiovascular and chronic diseases for adults.


1 , 2  OECD (2010), Health at a Glance: Europe 2010, OECD Publishing. 

Obesity Rates

*NEW* RADIAL-CUF

First clinically validated NIBP measurement for adult obese patients

GE CRITIKON* RADIAL-CUF 


  • Designed specifically for the forearm

  • Validated in a clinical study1

  • Provides proper fit and comfort to adult patients 

  • Gives reliable & accurate blood pressure readings

Challenge - accurate non-invasive blood pressure (NIBP) readings for adult obese patients

Until now, it is difficult to obtain accurate noninvasive blood pressure measurements on these patients because of the difficulty to select a properly sized BP cuff. Using traditional upper arm cuffs to measure NIBP from the adult forearm, is not clinically validated and leads to an underestimated systolic blood pressure by 10 mmHg on average.2

Cutting edge innovation in NIBP
Comfort, accuracy and infection control 

  • Comfort 

The GE CRITIKON RADIAL-CUF is designed to stay with the adult patients throughout their stay. This single patient multiple days cuff is made from soft absorbent material with rounded corners for patient comfort. 

  • Accuracy 

This latest cuff innovation now provides an accurate and validated measurement of radial arterial pressure for the obese patient group. It was carefully designed for the forearm and validated in a clinical study1 – and the first of its kind. 

  • Infection Control

This limited-reuse cuff can be paired with a single adult patient throughout the hospital stay, helping your infection control efforts.

Connecting intelligence and care


1. GE Healthcare sponsored and compensated Clinimark, LLC for managing and executing the clinical portions of this study. (March 2008/December 2011)    

2. Accuracy Study of a Noninvasive Forearm Blood Pressure Cuff in Comparison to Invasive Radial Arterial Blood Pressure. DOC1102668

Obese Patient Care

SPiO2

SPiO2

Monitoring SPiO2 parameters may help you optimize obese patients care:

SPI:

  • SPI (Surgical Pleth Index) monitors adult patients responses to opioids & surgical events during general anaesthesia.

  • SPI offers continuous and non-invasive monitoring solution.

  • Recent publications show that SPI monitoring helps to:
    - Reduce opioid amount by 22.7% to 25%
    - Maintain intra-operative hemodynamic stability
    - Optimize patient recovery

SpO2:

  • Continuous and non-invasive assessment of arterial oxygenation.

  • Accuracy and Performance, even in challenging situations. 

Challenge - Obesity and Drug Delivery


Pharmacokinetic properties of many drugs differ in obese patients compared with non-obese patients. Obesity and drug factors induce physiological changes and alterations in both drug distribution and elimination processes1-3.

As a consequence, obese patients may be more sensitive to the effects of sedative, opioid, and anaesthetic drugs, and often require postoperative ventilation period to allow safe elimination of residual anaesthetic or sedative agents4.   

While the use of regional anaesthesia may help to reduce these situations, it can be technically challenging in obese patients.   

Drug effects in obese patients are uncertain, which makes the monitoring of clinical end-points (such as heart rate, arterial pressure and sedation) more important than empirical drug titration based on published data3, 5, 6

Challenge - Obesity and Peri-operative Analgesia Management


Opioids like fentanyl, alfentanil and sufentanil are widely used to control hemodynamic and cardiovascular responses to nociceptive stimuli during surgical procedures and post-operative care units. In the obese patient, the use of opioid drugs may be hazardous may induce respiratory depression7.   

As the use of intramuscular route is not recommended, postoperative epidural analgesia has shown to provide better analgesia to obese patients8, 9.     

If the intravenous route is to be used, a patient-controlled analgesia system is probably the best option10. The use of target-controlled infusion has shown to be more effective in maintaining cardiovascular stability as compared with traditional weight-adjusted infusion11.   

However, tolerance to remifentanil in morbidly obese patients has been reported, suggesting to include corrections in opioid target-controlled infusion administration12.

Benefits


During surgical procedure of an obese patient, the monitoring of arterial pressure, pulse oxymetry, electrocardiography, capnography and neuromuscular block are all mandatory.   

SPI is an innovative parameter designed to monitor patients’ hemodynamic responses to surgical stimuli and opioid delivery.   

In addition to SpO2 measurements, all adult TruSignal* finger sensors provide Surgical Pleth Index (SPI) measurement. 

SpO2:

  • TruSignal SpO2 technology’s accuracy exceeds the requirements mandated by ISO 9919 pulse oximetry standard in all conditions.

  • Compared to existing alternative technologies, GE SpO2 algorithms have shown similar or superior SpO2 and Pulse Rate performances during motion conditions. 

SPI:

Continuous non-invasive SPI monitoring during general anaesthesia results in:

  • 22.7% to 25% reduction in remifentanil consumption

  • 85% reduction of peri-operative unwanted hemodynamic events

  • Faster patient recovery (eyes opening and patient extubation times shortened)

SPI index is part of the Adequacy of Anesthesia (AoA) concept which helps to assess patient’s responses to anesthetic agents, opioids and NMBAs during general anesthesia. Learn more about AoA concept...



1.      Abernethy DR. et al. Pharmacokinetics of drugs in obesity. Clin. Pharmacokinet. 1982; 7: 108-24.
2.      Abernethy DR. et al. Drug disposition in obese humans : an update. Clin. Pharmacokinet. 1986; 11: 199-213.
3.      Marik P. et al. The obese patient in the ICU. Chest 1998; 113: 492-8.
4.      Vaughan RW. Anesthetic management of the morbidly obese patient. In ; Brown BR et al. eds. Anesthesia and the Obese Patient. New York : Davis, 1982; 71-94.
5.      Shenkman Z. et al. Perioperative management of the obese patient. Br.J. Anaesth. 1993; 70 : 349-59.
6.      Arati Srivastava. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations J Minim Access Surg. 2010 Oct-Dec; 6(4): 91–94.
7.      Vaughan RW. Anesthetic management of the morbidly obese patient. In ; Brown BR et al. eds. Anesthesia and the Obese Patient. New York : Davis, 1982; 71-94.
8.      Brodsky JB. Et al. Epidural administration of morphine postoperatively for morbid obese patients. W. J. Med. 1984; 140: 750-3.
9.      Rawal N. et al. Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese. Influence on postoperative ambulation and pulmonary function. Anesth. Analg. 1984; 63: 583-92.
10.   Bennett R. et al. Variation in postoperative analgesic requirements in the morbidly obese following gastric bypass surgery. Pharmacotherapy 1982; 2: 50-3.
 11.   De Castro V. Target-controlled infusion for remifentanil in vascular patients improve hemodynamics and decrease remifentanil requirement. Anesth. Analg. 2003; 96:33-8.
12.   Albertin A. et al. Effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index guided propofol anesthesia in seriously obese patients. Inerva Anestesiol. 2006; 72: 915-24. 

Adequacy of Anaesthesia (AoA)

enFlow IV Fluid/BloodWarmer

enFlow IV Fluid/Blood Warmer 

  

enFlow* IV Blood/Fluid Warmer helps to maintain normothermia and optimize obese patient care.   

Challenge - Obesity increases the risk of nosocomial infections1,2 

With this complex patient population, the optimization of patient care and safety is essential3.   

Post Bariatric body contouring and Bariatric surgery (as Roux-en-Y gastric bypass) is associated most of the time with long operative times and high rates of complications. 

Maintaining normothermia is a critical component of perioperative management4. 

In a study “Hypothermia and complications in postbariatric body contouring”4, Coon D & al have shown that lower intraoperative temperature was associated with an increased risk of: 

  • seroma formation

  • blood loss

  • the need of transfusion 

The authors have adopted a protocol involving patient prewarming, a higher operative room temperature , and the routine use of warmed fluids. 

When it comes to fluid warming, the enFlow system delivers the right temperature in the right place at the right time.   

Hypothermia during and after major abodominal surgery decreased host defenses, increases the incidence of coagulopathy and may alter blood pressure, cardiac contractility and myocardial stability5

Operatives consideration such as hypothermia prevention can play a role in improving outcomes and reducing mordibity in postbariatric body contouring6 .

Evidence based Guidelines for operative management are needed. Hedrick & al has shown that after implementation of a multidisciplinary protocol, including strict maintenance of patient normothermia intraoperatively and in the recovery room, the incidence of Surgical Site Infection decreases by 45% in the overweight population7.

Learn more about enFlow IV Fluid/Blood Warming System



1.   William G. Cheadle , Risk Factors for Surgical Site Infection, Surgical Infections. Volume: 7 Issue s1: October 10, 2006 
2.   Jon Stuart Hourigan, Impact of Obesity on Surgical Site Infection in Colon and Rectal Surgery, Clin Colon Rectal Surg 2011;24:283–290 
3.   Amy S. Colwell, Optimization of Patient Safety in Postbariatric Body Contouring: A Current Review, Aesthetic Surgery Journal July 2008 vol. 28 no. 4 437-442  
4.   Coon D, Hypothermia and complications in postbariatric body contouring , Plast Reconstr Surg. 2012 Aug; 130(2):443-8. 
5.   Mason DS, Influence of a forced air warming system on morbidly obese patients undergoing Roux-en-Y gastric bypass, Obes Surg. 1998 Aug;8(4):453-60.


enFlow IV Blood/Fluid Warmer helps to maintain normothermia and optimize obese patient care.