title: Perioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI Consensus.
abstract: Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose Body Mass Index (BMI) is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population. Obesity is a multisystem, chronic, proinflammatory disorder. Unfortunately many countries are facing a marked increase in the obese population, defined as "globesity". Obesity presents an added risk in hospital, leading health care organizations to call for action to avoid adverse events and preventable complications. Periprocedural assessment and critical care strategies designed specifically for obese patients are crucial for reducing morbidity and mortality during surgery and in emergency settings, critical care and other particular settings (e.g., obstetrics). Specific care is needed for airway management, as are proactive strategies to reduce the risk of cardiovascular, endocrine, metabolic and infective complications; any effort can be fruitful, including special attention to the science of human factors. The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving other national scientific societies to increase risk awareness, define the best multidisciplinary approach for treating obese patients in election and emergency, and enable every hospital to provide appropriate levels of care and good clinical practices. The Obesity Project Task Force, a section of the SIAARTI Airway Management Study Group, used a formal consensus process to identify a series of notes, alerts and statements, to be adopted as bundles, to define appropriate clinical pathways for hospitalized obese patients. The consensus, approved by the Task Force and endorsed by several European scientific societies actively operating in this field, is presented herein.
authors.affiliation: Department of Perioperative Medicine, Pain Therapy, Rapid Response Systems and Intensive Care, DEA, University of Chieti-Pescara, ASL2 Abruzzo, Chieti, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Petrini
authors.affiliation: Anesthesia, Polyvalent Intensive Care and Transplantation Unit, Department of Organ Failure and Transplantation, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University, Bologna, Italy - digiacintoida@gmail.com.
authors.forename: Ida
authors.initials: I
authors.lastname: Di Giacinto
authors.affiliation: Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Cataldo
authors.affiliation: Department of Anesthesia and Postoperative Intensive Care, Ospedali dei Colli, Monaldi Hospitals, Naples, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Esposito
authors.affiliation: Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care, Santa Maria Nuova Hospital, Florence, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pavoni
authors.affiliation: Intensive Care Unit, Department of Anesthesia, Maggiore della Carità University Hospital, Novara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Donato
authors.affiliation: Anesthesia and Critical Care Medicine Unit, Department of Perioperative Medicine, Pain Therapy, Rapid Response Systems and Intensive Care, DEA, University of Chieti-Pescara, ASL2 Abruzzo, Vasto, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Trolio
authors.affiliation: Department of Anesthesia and Intensive Care Unit, Maggiore Hospital, Crema, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Merli
authors.affiliation: Past Chair of the SIAARTI Airway Management Study Group.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Sorbello
authors.affiliation: Anesthesia and Intensive Care Unit, AOU Policlinico Vittorio Emanuele University Hospital, Catania, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
mesh_terms: D026683:Advisory Committees; D058109:Airway Management / Q000379:methods*; D000776:Anesthesiology; D015992:Body Mass Index; D003422:Critical Care; D005260:Female; D006801:Humans; D007558:Italy; D009765:Obesity / Q000145:classification / Q000150:complications; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy; D012955:Societies, Medical