Anaesthetic and high BMI

[teachandsleep]

I'm due to have a hysteroscopy amd multiple polyps removed. I've had my pre op and have now been called to have a pre anesthetic assessment with the anesthestist. I've had this type of surgery before with just a pre op. Why have I been called to this appointment? Will my surgery still go ahead? My bmi is 52.

[flickeringcandle45]

www.ouh.nhs.uk/patient-guide/leaflets/files/11849Pbmi.pdf

The anaesthetist will want to ensure that you fully understand the risks you will be running. They may also encourage you to take action to mitigate these risks before any planned surgery goes ahead.

[missmeg3leg]

hi teachandsleep

standard procedure in my nhs trust (work in gynae theatre) we have standard pre-op, face to face with pre-op nurses or telephone but also have anaesthetist led clinic for high risk patients, med reasons, high BMI etc to ensure fit for surgery & risks explored.
Have you asked your gynae surgeon possibility of procedure under LA or does your hospital offer outpatient techniques?

[PurpleGhost]

Would it be possible to have it done with a epidural/spinal anaesthesia? They might want to talk about that I suppose.

I've got a high BMI and when I broke my ankle and it needed pinning it was done that way as proper anaesthesia was much higher risk.

[teachandsleep]

Thanks missmeg3leg


Just wondered why as I have had 2 GA's before and have never had to see anaesthetist before prior to surgery.

[Fretfulparent]

When you had your previous operation what was your BMI and how long ago?

[Deadheadstickeronacadillac]

Same as @Fretfulparent, if your BMI has significantly increased from previous surgery then they will have to discuss as the risks under anaesthetic are extreme.
I was refused hip replacement due to BMI of 55 solely because of the anaesthetic risk (was private not NHS before anyone has a go). Had to get BMI below 39 before the anaesthetist would consider. Only way was bariatric surgery and even with very very specialist bariatric aneathatists there were many concerns.
I actually got through 6 surgeries in 2 1/2 years (4 of them with health insurance but the bariatric cost 17,000) with no problems under anaesthetic but every time I had to meet with them and I always told them to do what they needed to do -they had carte Blanche to knock me out with whatever drugs (a lot because I was on morphine) and tbh whatever happened would happen. This seemed to reassure the anaesthetists most as they knew they didn't have to worry about permissions and could make their own decisions.
This whole story really puts who I am, but am under 40 so very young for hip replacement.
Good luck with the surgery

[Deadheadstickeronacadillac]

*outs not puts!

[teachandsleep]

My bmi was 48 last time and it was 2016

[Fretfulparent]

Guidelines change and improve all the time so I suspect in 2016 either the nurse doing the pre-op check didn't need to refer you to see an anesthetist or there wasn't the option.


Nowadays there are more detailed pre-op guidelines and risk calculators available so the risks are more tangible.

Here for example:

www.ncepod.org.uk/sort.html


Previously they may have just said that you are at higher risk of bleeding ( for example) but now they may tell you that you have a 30% increased risk of bleeding and so they will cross match a unit of blood beforehand in case.

Following countrywide tragedies and official inquiries every hospital now has a pre-op policy to try to reduce the risks for patients. Here is a very detailed one

doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/Anaesthetics/PreAssessmentClinicalGuidelines.pdf