Childhood obesity and anesthetic morbidity

Background: Obesity is present in a significant proportion of children presenting for anesthesia. Although it is perceived that obese adults have more frequent complications, the incidence of complications in obese children is unknown. Because of anticipated difficulties with mask ventilation, anesthesia is most frequently induced intravenously in obese adults, whereas inhalation induction is usually preferred in uncooperative children with few visible veins. The purpose of this study was to examine and compare anesthetic related complications in obese children undergoing dental surgery with a similar group of nonobese individuals. Methods: The charts of 1133 American Society of Anesthesiology (ASA) physical status I and II children less than 12 years old who underwent general anesthesia for dental outpatient procedures in 2003 were retrospectively examined for patient height, weight, preoperative evaluation, anesthetic course and postoperative course. Body mass index was calculated and compared with international normative data to identify those children who were obese. Method of induction and perioperative complications were noted. Results: A total of 100 obese and 1033 nonobese children were identified. Demographically the two groups were comparable. Inhalation induction was used in the vast majority of obese (99%) and nonobese (99.7%) patients. Overall complication rate was low. Minor respiratory complications were more frequently noted in the obese group. These consisted primarily of a higher incidence of intraoperative oxygen desaturation (2% vs 0.19%) and higher requirements for unexpected overnight hospitalization (2% vs 0.19%). The only complication related directly to inhalation induction was noted in a nonobese child who vomited and aspirated on induction. Conclusions: Our study demonstrated a small increase in minor respiratory complications in obese children who underwent anesthesia. Inhalation induction was not associated with an increase in adverse events in this population.