Emergency in obese patients: a reply to SOBA UK
Journal of Anesthesia, Analgesia and Critical Care volume 2, Article number: 12 (2022)
Emergency settings in obese people require tailored multidisciplinary protocols and pathways to manage these complex patients. For this reason, we would like to foresee a proficient cooperation with the UK Society for Obesity and Bariatric Anaesthesia (SOBA) and other societies: obesity is a worldwide problem, and an international and multidisciplinary cooperation is desirable, if not needed. As demonstrated for bariatric surgery, a standardizing anesthesiologic and critical approach and an experienced multidisciplinary staff, trained and equipped to manage obese patients, are related to better outcomes. Similarly, as recently pointed out for airway management safety, we believe that the presence of an obese lead should be a desirable goal to reach in the next future, especially when thinking of emergency situations and the need for resuscitation of obese patients. A worldwide problem calls for worldwide cooperation.
We read with interest and really appreciated the comments by Dr Mckechnie and colleagues  on our recent review . We believe that the most important issue raised by our colleagues’ letter is the ubiquitous attention to obesity, and its implications for perioperative and emergency care. We would like to develop collaborative working between the UK Society for Obesity and Bariatric Anaesthesia (SOBA) and other societies: obesity is a worldwide problem, and an international and multidisciplinary cooperation is desirable, if not needed.
Tailored multidisciplinary protocols and pathways to manage these complex patients are required. We believe that dedicated teams should be adequately trained for both technical and non-technical skills for emergency and perioperative management of this heavily frail population, including resuscitation, advanced procedures, and transport. Education, training, simulation and organization are the only tools we believe appropriate to face the challenge of “Globesity”, a pandemic without vaccine. Not by chance, the interest of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) regarding patients with obesity has widely increased in the recent years, leading us to publish consensus, good clinical practices, and itinerant training programs among clinicians [3, 4].
As demonstrated for bariatric surgery, standardizing the anaesthetic and critical care approach, alongside an experienced multidisciplinary staff, trained and equipped to manage patients with obesity, is related to better outcomes [5, 6]. Similarly, as recently pointed out for airway management safety , we believe that the presence of a lead for obesity, aiming to ensure indications and supply of dedicated obesity equipment, diffusion of knowledge including implementation of practice guidelines, organizational and educational programs, should be a desirable goal to reach in the near future. This is especially important when thinking of emergency situations and the need for resuscitation of patients with obesity .
Despite evidence showing the need for closing these specific gaps, and the further lessons from COVID-19 pandemic, which heavily affected the population living with obesity on one hand , and demonstrated the importance of structured and teamwork approach on the other , no specific recommendations have been published yet regarding life support for patients with obesity.
This may depend on the lack of high-quality evidence, so we believe that the first common effort of international societies should be high-quality research to build such evidence and to develop shared consensus documents.
A worldwide problem calls for worldwide cooperation.
Availability of data and materials
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we thank the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the UK Society for Obesity and Bariatric Anaesthesia (SOBA) for their efforts in promoting the research on this topic. Moreover the Authors wish to thank Dr McKechnie and Dr Pengelly of SOBA UK for their advice on this manuscript in terms of future intersocietary collaboration.
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MS has received paid consultancy from Teleflex Medical, Verathon Medical and DEAS Italia, is a patent co-owner (no royalties) of DEAS Italia and has received lecture grants and travel reimbursements from MSD Italia, MSD USA. ID, SF and GC have received lecture grants and travel reimbursements from MSD Italia. GC has also received lecture grants and travel reimbursements from Baxter Italia. No external funding or other competing interests were declared.
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Di Giacinto, I., Guarnera, M., Esposito, C. et al. Emergency in obese patients: a reply to SOBA UK. J Anesth Analg Crit Care 2, 12 (2022). https://doi.org/10.1186/s44158-022-00040-z