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The three obesity societies, ESPCOP, ISPCOP and SOBA-UK  have joined forces and combined efforts to provide an International Federation of Obesity Anaesthesia groups, in order to further their commitment towards education and safety in anaesthesia and peri-operative care of the obese patient.

Talking with... their new elected Presidents about this unique collaboration under the OBESITY ANAESTHESIA heading.

"It is very early days, but would you like to give us an insight into  the future of ….a federation, an IFSO anaesthetic equivalent?”

“The future of an International Federation of Obesity Anaesthesia societies will need to start with mapping already existing initiatives and societies involved in perioperative care of the obese patients. In these days of limited means, there is a need to try and unite these initiatives in a broader forum. A worldwide forum for establishing practice guidelines with collective research, scientific and educational efforts. “

 

“The primary impetus behind the federation is to achieve critical mass. On our own, we have made small but significant steps in the right direction. Together we will be able to set the agenda for improving perioperative care of the severely obese.”

“The summative experience of these initial three societies is very powerful for our members and the future direction of our specialty learning. SOBA-UK is immensely proud to be a part of this federation. “
Luc de Baerdemaeker
ESPCOP President
Stephanie Jones
ISPCOP President
John Cousins
SOBA-UK Chairman

News From Around the World

What’s on now?

Join us!

Premiere

IARS 2015 MEETING and International Science Symposium



March 21-24, 2015,HAWAII, Honolulu Aloha! Discover All the Obesity Anaesthesia Sessions!
  • PHARMACOLOGY OF PHAT – DRUGS AND DOSING IN THE SEVERELY OBESE
 Anu Wadhwa, Cindy M. Ku, David Torres, John Mitchell
  • PBLD’s - BIG PROBLEMS: AIRWAY MANAGEMENT, POSITIONING ISSUES, AND ANALGESIC OPTIONS IN THE SEVERELY OBESE PATIENT
 Anu Wadhwa, Rainer Lenhardt.
 

SOBA-UK, ESPCOP and ISPCOP  organize  for the first time at 20th IFSO World Congress one day and a half of Obesity Anaesthesia:
  
  KEY  ISSUES IN OBESITY  PERI-OPERATIVE CARE

  DIFFICULT AIRWAY HANDS-ON WORKSHOP




 See the programme soon -www.ifso.com

Welcome message – Prof. dr. Luc de Baerdemaeker - President ESPCOP

 

Introduction:


In accordance with the bylaws of ESPCOP, elections of the officers to the board were held in 2014.
Elections were held prior to the annual scientific meeting in December 2014, which this year took place in Ghent, Belgium. In addition to the offices of President, Vice-president, Treasurer and Secretary, we introduced the position of IT officer/webmaster. 

 

Results of the election were:


President: Luc De Baerdemaeker (Belgium)
Vice president: Mike Margarson (UK) 
Secretary: Yigal Leykin (Italy)
Treasurer: Jan Mulier (Belgium)
IT officer/webmaster: Daniela Godoroja (Romania)

As the new president, I would like to thank the previous ESPCOP board for their efforts and contributions to get this society to the stage where we are today. 

Special words of thanks of course to our affiliate members from ISPCOP and SOBA in helping to keep the interest in perioperative care for the obese patient going.

Our previous president, Jan Mulier, deserves more than a simple thank you for his relentless input and effort to make this joint international project successful. 

At the same time, I would like to introduce and give a warm welcome to Mike Margarson and Daniela Godoroja as new ESPCOP board members.  

At the annual scientific meeting in Ghent, Prof Jan Mulier announced the financial report of ESPCOP, indicating that we have a positive balance sheet.  

 

Future plans and goals:


One of the challenges for this new board will be to keep the momentum going. 
So far, we have been successful in using the platform offered by ESA, ASA and other big international societies to organise sessions in international meetings with international speakers. 

The past few years, we have followed the early years of the ESA with Brussels/Belgium as our base, but like ESA we would like to spread out and try to organize our annual meeting in other European countries.  

There is a risk that we will see a plethora of societies and organisation involved or active in organizing obesity related initiatives. In these days of limited means, it might be a good idea to try and unite these initiatives in different continents in a federation for perioperative care for the obese patients.

ESPCOP, ISPCOP, SOBA, SASM,  ... all these societies have a lot in common. By joining forces we can share our interests and efforts and create a network for exchange of ideas and speakers, moving towards further shared meetings with other societies. 

ESPCOP will be happy to help develop such co-operative working. 

And finally, I hope we can get a wider group of interested colleagues involved, in order to keep this society vibrant and fresh, with new ideas and new faces moving us forward.. 

Kind regards,
Luc De Baerdemaeker
President of ESPCOP

SOBA UK    …at a glance towards… Obesity Anaesthesia



In December we had a change of committee following the AGM and elections and it would be worth checking out the new names and faces of the SOBA council. For me it is the start of a two year journey working to bring SOBA through to the next level. So much has been achieved but still so much to do to put obesity anaesthesia firmly into our training and share all the best practice from the UK and beyond. We will be using the website with twitter much more and these federation newsletters to stay in touch. 
Send us your views please.
Some notes from the council are below.

 

Very Best Wishes’ for now  John Cousins and the New Council – Spring 2015


Excited? We are!
SOBA, ISPCOP and ESPCOP have very similar aims and goals but different educational models, populations and medical educational styles in our regions. This year sees the beginning of the new era of collaboration a Federation of these three main societies for the benefit of all members. The SOBA council and membership are keen to be a major part of this new initiative and more of this in the main newsletter.

 

SOBA membership


Our membership is growing year on year and so is our educational outflow. SOBA is the product of its members knowledge and experience so please get involved and tell us what you think the next directions/aims should be. Get in touch via the website www.sobauk.com
 

Peri-operative Medicine


SOBA was well represented at the Royal College Of Anaesthetists meeting on planning the changes in anaesthetic training to push forwards the anaesthetist as a peri-operative physician. 

Bariatric anaesthetists in many institutions already perform this role by active involvement in the pre-operative assessment clinics, running high-risk clinics and standing tall at the MDTs.

We spoke to the committee running this initiative at RCOA 
and suggested that an easy place to trial this change in role might be in selected bariatric services across the UK. 
So watch this space and be ready to volunteer should we get this opportunity offered via SOBA.
Well worth looking at the short video clip explaining the ethos and aims of the RCOA to see how practice should change.


 

May 6th SOBA meeting


Once again SOBA is going to run two conferences this year will be a part of many others.
On May 6th  in London - we see the return of the highly acclaimed training day aimed at all levels of experience, for obesity and bariatric anaesthetists. An excellent opportunity to update your CEPD, gain insights into the issues faced by all of us across the UK and for trainees to fill the gap left in your programmes on focussed obesity related issues. Cheap at £125 until 6th April. See www.sobaconference.com to book a space ASAP, this course sells out fast.


New Committee


In December we saw the AGM and Election of the new Council – which has been very busy setting aims and goals to take SOBA forwards for the next two years. Have a look at the new www.sobauk.com website to see who is who in the new council, contact them, read publications and help make SOBA what the membership wants and needs. 
A good read is the outgoing statement of Nick Kennedy in the news section reflecting on the last 4 years of SOBA works.


New Websites


As part of the SOBA revamp we have decided to modernise the websites and content which SOBA offers. So do look at both websites and feedback to us any typos or areas you want included.


Exciting downloads area on the website


Beside individual training and education we want SOBA to distribute useful facts, videos and downloads to our members and all anaesthetists. So this is an area of the site we expect much growth over the next 12months. Currently hosting the SOBA DVD, the popular Single Sheet Guideline, core topics statement and a leaflet on weight loss in anaesthetic Pre Operative Assessment Clinics. More to follow.


IVC filters


The VTE risk in obesity is a much disputed area, with a paucity of proper evidence and collation of data/risk. The National Bariatric Surgical Register database implies a much lower risk of VTE than shown in USA data/studies. So, is this because we are delivering better care in the UK or is there an over estimation in USA data or an underestimation in UK data?… A thorny issue sure to be explored in the ensuing years. But some issues are becoming clear. Early this year we saw a definitive systematic review on IVC filters evidence for use in obese bariatric surgical patients. Summary: There is no evidence to show any potential benefits that actually outweigh the significant risks of this therapy.  [ Rowland SP et al Annals of Surgery 2015; 261(1): 35-45. ]













 Abigail Hine, MD, IT lead SOBA-UK

ISPCOP has had an outstanding year of forward progress. 


Our 3rd Annual Symposium during the 2014 ASA annual meeting in New Orleans was a great success.  The monsoon-like rainstorm immediately prior may have limited our attendance somewhat, but over 30 hardy souls enjoyed refreshments, fellowship, and excellent lecture presentations by Dr. Glenn Murphy (Neuromuscular Blockade and 

Reversal for Bariatric Surgery), Dr. Satya Krishna Ramachandran (Obstructive Sleep  Apnea and Respiratory Failure: Perioperative Pathophysiology and Outcome Modification) and Luc de Baerdemaeker (Dosing of Antibiotics in the Morbidly Obese). 

The lectures were followed by a new scientific session.  Abstracts were solicited and graded by members of the Board of Directors. The top four abstracts were selected for oral presentation, and another 8 presented as posters.  Dr. Roman Schumann was the recipient of the ISPCOP Research Award for the top scoring abstract, entitled “Minute 

Ventilation Formulas in Obese Surgical Patients: Evaluation of the accuracy of Standard Formulas”. Lively discussion followed both the lectures and abstract sessions.  The oral presentations and several of the posters are posted under the ASA 2014 tab on the website for your viewing pleasure.  Planning is underway for the 2015 Symposium on 


October 26, 2015 including a keynote address by noted researcher Dr. Paolo Pelosi. 

Please submit your research abstracts when the call goes out this summer and join us in San Diego for what will surely be an engaging evening.


Obesity Week in Boston this past November was another forum for ISPCOP member presentations.  We did a half day combined course with ASMBS surgeons on best practices for bariatric surgery, and a 90 minute Level 2 Partner symposium on metabolic syndrome and obesity in the perioperative period.  Both were extremely well received with overall and individual speaker ratings well over 4 on a 5-point scale.  

We have applied to renew our Level 2 Partnership status and hope to grow our presence at this unique multispecialty and multidisciplinary meeting.  

 

Latest in Weight Loss Strategies to be Unveiled at Premier International Meeting for Obesity Science & Treatment


ISPCOP is developing a relationship with the International Anesthesia Research Society (IARS)as well.  Members proposed program content for the Annual Meeting in Honolulu, Hawaii this month as well as reviewing abstract submissions. Our society 

Secretary, Dr. Anu Wadhwa will moderate the ISPCOP panel “Pharmacology of phat – drugs and dosing in the severely obese” as well as lead an obesity-themed PBLD session with board member Dr. Rainer Lenhardt.  We look forward to continuing participation in the IARS to the mutual benefit of both societies.  Suggestions for the 2016 program are welcome!

We have an ongoing offer from Bariatric Times for anesthesia content.  This is open to anyone in ISPCOP, ESPCOP or SOBA.  Take a look at the links on the ISPCOP website to see what has been covered previously  [http://www.ispcop.org/index.php/publications/bariatric-times].  Specifications are 700-1000 words, plus figures/tables/photos. 

A great opportunity to educate your surgical and anesthesia colleagues on your area of interest.  ISPCOP is also looking for educational website content: member publications, recorded lectures, power point presentations.  Show off your hard work and get the word out on why our organizations exist.  If interested, email your proposed topic to ispcopmembership@gmail.com.

We need to get the word out and expand our membership.  The more members we have spreading the message of how to optimize perioperative care for the severely obese the better it will be for our patients.  Next mission: establish the research agenda.  Please visit www.ISPCOP.org for more information on the society and membership.





 







Stephanie Jones, 
MD- President ISPCOP

Editor’s Notes
 

Propofol Dosing: Getting it right in the morbidly obese




Anesthetic Induction Propofol Dosing in Morbidly Obese: Lean Body Weight or Guided by BIS?


In a study from Toronto published in abstract format last year, researchers found that in patients with morbid obesity, that propofol target induction doses based on LBW were consistently lower than those doses based on a target BIS level of 50. They suggested (somewhat controversially) that LBW dosing resulted in insufficient depth of anesthesia in 60% of cases. 

Clinical Anesthesiology vol 39;11,Nov.2013



Not surprisingly this attracted comment from several including a comment from Jerry Ingrande -Stanford University School of Medicine:

“Our recent review examining dosing scalars for the induction dose of propofol in obese individuals found that LBW was the most appropriate weight-based scalars. The hysteresis between processed electroencephalogram (EEG) and drug effect, leading to a lag time between loss of counsciousness and BIS values, will result in administration of excess propofol. 

The increased volume of distribution (fat mass increases to a greater extent than LBW) and the raised cardiac output underlie the historical common practice of dosing the induction and maintenance doses of propofol to TBW, predisposing the patient to inappropriate side effects as hypotension.”


http://bja.oxfordjournals.org/content/105/suppl_1/i16.long

 

5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland


The results of NAP5 in September 2014 indicate that induction is a highest risk phase of anaesthesia for Accidental Awareness during General Anaesthesia (AAGA), and that this may be more common in the obese. 

One of the more controversial recommendations made in this report was that.. “This raises the possibility that dosing of induction drugs based on total body weight might be a better strategy to reduce the risk of AAGA.”

http://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/the-5th-national-audit-project-nap5-accidental-awareness

This did not sit comfortably with the international obesity anaesthesia community and SOBA replied:

“In summary, we very much welcome the NAP 5 report but would urge caution in following any recommendation to dose obese patients to total body weight. We are very concerned that significant overdosing of obese patients during induction to try to avoid the small but important risk of awareness might engender more immediate patient safety problems. As an alternative we would encourage the use of initial dosing to lean body weight, with adoption of some of the techniques described.”

http://bja.oxfordjournals.org/content/113/4/549.abstract/reply - brjana_el_12025

 

Lean Body Weight can be accurately measured!


Although LBW is a useful dosing metric for many anaesthetic agents, its use as a weight scalar in the MO population has been limited by the relative inability to accurately measure it under normal clinical circumstances. (James equation, Janmahasatian and Allometric scaling  were used to calculate LBW)

http://bja.oxfordjournals.org/content/105/suppl_1/i16.long


Callaghan and colleagues  presented “An aid to drug dosing safety in obese children: development of a new nomogram and comparison with existing methods for estimation of ideal body weight and lean body mass”- Anaesthesia 2015, 70, 176–182

http://onlinelibrary.wiley.com/doi/10.1111/anae.12860/abstract

Body composition (lean body mass and fat mass) were accurately measured by dual-energy X-ray absorptiometry on 1161 patients in Look Ahead Study (Changes in Body Composition Over 8 Years in a Randomized Trial of a Lifestyle Intervention: The Look AHEAD Study)

http://onlinelibrary.wiley.com/doi/10.1002/oby.21005/epdf

 

Research


Researchers found the regulating effect of propofol on the endocannabinoid CB1 system from basolateral amygdala decreased the anterograde amnesic effect of propofol under some conditions(when CB1 receptors are  blocked), which might be a risk factor for intraoperative awareness. 

Propofol TIVA-related intraoperative awareness might not be due to its interaction with the CB1 system (Neuroscience Letters, Volume 584, 1 January 2015, Pages 287–29)

http://www.sciencedirect.com/science/article/pii/S0304394014008684






 








Daniela Godoroja, MD

 

Who can better tell a story than someone with personal experience?
 

Please tell us your story about the care of obese patients.


If you would like to submit an article or give us your feedback, please contact us: 

newsletter@obesityanaesthesia.org




 

Newsletter Editor feedback and suggestion are very welcome!





Newsletter Editor : Daniela Godoroja 
Newsletter Editor SOBA-UK: Abigail Hine
Newsletter Editor ISPCOP: David Torres
Newsletter Language Editor: Mike Margarson 
Copyright © 2015 ESPCOP, All rights reserved.


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