Childhood obesity leads to higher rate of problems during surgery

Add this to the growing list of health challenges faced by obese children: A new study from the University of Michigan Health System finds that obese children are much more likely than normal-weight children to have problems with airway obstruction and other breathing-related functions during surgery.

Obese children were found to have a higher rate of difficult mask ventilation, airway obstruction, major oxygen desaturation (a decrease in oxygen in the patient's blood), and other airway problems. The study appears in the March issue of the journal Anesthesiology.

"To our knowledge, this is the first study of its kind," says lead author Alan R. Tait, Ph.D., professor in the Department of Anesthesiology at the U-M Health System. This large-scale prospective study examines the effect of overweight and obesity on the outcomes of operations in children undergoing elective non-cardiac surgery.

"Based on current trends, it is likely that anesthesiologists will continue to care for an increasing number of children who are overweight or obese," Tait says, "so it is vital that we are aware of the higher risk they face in the operating room."

Researchers studied the experiences of 2,025 children who were having elective surgery. Of those, 1,380 were normal weight, 351 were overweight and 294 were obese. Children ranged in age from 2 to 18 years old.

In addition to the problems the obese patients experienced during surgery, they also had a higher rate of illnesses and conditions including asthma, hypertension, sleep apnea and Type II diabetes. These conditions all can contribute to problems during surgery, Tait notes.

By the numbers:

• An estimated 15 to 17 percent of children and adolescents in the United States are considered obese.
• Major airway obstructions occurred in 19 percent of obese children, compared with 11 percent of normal-weight children.
• Nearly 9 percent of obese children experienced difficult mask ventilation, compared with 2 percent of normal-weight children.
• 17 percent of obese children in the study experienced major oxygen desaturation (decreased oxygen in the blood), compared with 9 percent of normal-weight children.
• 28 percent of obese children had asthma, compared with 16 percent of normal-weight children.

It should be noted however, that despite the increased risk of adverse events among children who are obese, none resulted in significant illness.

In addition to Tait, authors were Ian Lewis, MBBS, MRCP, FRCA; Terri Voepel-Lewis, MSN, RN; Constance Burke, BSN, RN; and Amy Kostrzewa, M.D., all of the U-M Department of Anesthesiology.

The research was funded by the U-M Department of Anesthesiology.

Reference: Anesthesiology, March 2008, Vol. 108, Issue 3.