Analgesia for Bariatric patients

Dr Jonathan Cousins,
Consultant Anaesthetist & Co-founder of Society of Bariatric Anaesthetists,
Imperial College Healthcare NHS Trust.

Biography
Dr. Jonathan Cousins is a Consultant Anaesthetist at Imperial NHST.  He has a particular interest in clinical anaesthesia and research in the peri-operative field of bariatrics (weight loss surgery) and with this comes experience in dealing with morbid and super morbidly obese patients for all surgery types.  Two years ago he set up the Society of Bariatric Anaesthetists UK and a year ago the European version to encourage the distribution of best practice and enhance research quality centrally.  With the society, he is working on defining training competencies for consultants and trainees in anaesthesia.

One of the main aims of the society is to spread the knowledge and experience gained by those working with the super obese daily to enhance the care given to all obese patients.

Abstract
This session will attempt to highlight the issues surrounding care and effective analgesia delivery for the obese patient.  We will briefly describe the new surgeries of bariatric or weight loss operations that are becoming widely available across the NHS.  To better understand the differences between normal BMI and morbid obesity we will draw upon the experiences gained in treating the super-morbidly obese.
Choosing an analgesic regimen is fairly simple, but this patient group can raise specific challenges, so the practical difficulties of delivering high quality analgesia will be covered.  There will only be a very brief discussion on the pharmacokinetics as it pertains to the altered phamacodynamics in obesity.  Good references are rare, but these three represent a good basis for enabling local policy and dispelling myth. 

Anaesthesia for the Overweight and Obese Patient:  Mark Bellamy & Michel Struys

Pharmacokinetics in obese patients:  De Baerdemaeker et al. Contin Educ Anaesth Crit Care Pain.2004; 4: 152-155

Anaesthesia and morbid obesity:  Lotia and Bellamy. Contin Educ Anaesth Crit Care Pain .2008; 8 (5): 151.

Anesthesia in the obese patient: Pharmacokinetic considerations.  Journal of Clinical Anesthesia - Volume 17, Issue 2 (March 2005)