Anaesthetic nurse specialist role in perioperative anaesthetic management of patients who are morbidly obese
This integrative literature review examined the role of an anaesthetic nurse specialist (ANS) in the perioperative anaesthetic nursing management of morbidly obese patients associated with elective orthopaedic surgery. The responsibility of the ANS is to provide high-quality perioperative anaesthetic care to ensure patient safety. Morbid obesity is increasing globally, with significant implications for healthcare delivery, care and treatment, including perioperative care. The Association of Anaesthetists of Great Britain and Ireland emphasises that the perioperative management of these patients presents significant organisational and practical issues. However, there are limited data or guidelines on whether surgeons, anaesthetists and nurses routinely take special precautions in managing morbidly obesity patients undergoing elective orthopaedic operative procedures. The authors carried out a search of databases, followed by an integrated literature review and synthesis of 11 studies. The main findings revealed significant clinical challenges and resource requirements for perioperative anaesthetic management of this patient group. Recommendations are made to prepare for and manage these surgical patients, from preoperative assessment to postoperative care.
Surgery in patients who have morbid obesity is considered high risk and concerns have been raised among patients and surgeons regarding the outcomes and complications of orthopaedic procedures, such as joint replacements, in this patient population in the UK. To reduce the risk necessitates careful planning, pre-operative risk assessment, adequate anaesthetic management, strict thrombolytic event prevention, and effective postoperative pain control (Nightingale et al, 2015). Wang et al (2017) highlighted that special training is necessary when providing care to a patient who is morbidly obese. Failure by nursing staff to recognise complications can lead to a delay in appropriate and timely management, and even lead to death. Public Health England (2017) and National Institute for Health and Care Excellence (NICE) (2022) have highlighted that special equipment is required for this patient group to ensure safe working practices and reduce risks to staff. Patients who are morbidly obese require individual ‘tailored’ plans (Lotia and Bellamy, 2008). A detailed anaesthetic assessment may be performed for an elective procedure, emergency surgery, or obstetric anaesthesia or analgesia.
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