PERIOPERATIVE ANESTHETIC ANTIOBESITY MEDICATION MANAGEMENT: CLINICAL PRACTICE GUIDELINE

Problem and Purpose: By 2030, it is expected that 45% of the US population will be obese which correlates with an increased use in antiobesity medications, 2.35 million to 2.74 million between the years 2008 and 2011. These increasing trends have led to an increased number of surgical patients consuming antiobesity medications. For the anesthesia provider, antiobesity medications are not amongst commonly encountered medications which results in varied experience. A local hospital in Maryland expressed the need for the development of an evidence based clinical practice guideline (CPG) regarding the anesthetic management of antiobesity medications. Due to the wide variations in antiobesity medications, the CPG focuses on current U.S. Food and Drug Administration (FDA) approved antiobesity medications including their medication specific anesthetic implications and associated interventions. Methods: Guideline development included input from an expert panel, which included an anesthesiologist, two nurse anesthetists, pharmacist, and a Doctor of Nursing Practice (DNP) student. A CPG draft was created and assed via the AGREE II tool which provides a systematic approach to assess guideline quality. After members of the exert panel completed the AGREE II Tool, revisions were made, and an updated draft guideline was completed. The final draft was presented to anesthesia providers during a departmental meeting accompanied by a Provider Feedback Questionnaire (PFQ). Feedback from the PFQ was used to further revise the CPG to best fit the needs of the institution. A final guideline was then presented to the Chief Nurse Anesthetists, the Chief Anesthesiologist and Vice-Chief Anesthesiologist. After presentation, the Chief Anesthesiologist gave final approval for project continuance. The finalized approved CPG was disseminated to the anesthesia department electronically via email to promote ease of access. To facilitate sustainability, a CPG change champion was identified and is responsible for continued advocacy and guideline updates. Results: The overall average CPG AGREE II assessment score was 85%, indicating moderate guideline quality with key stakeholders recommending guideline use in the organization. The PFQ revealed an overall agreement percentage of 82.5% indicating applicability of the guideline for providers at the specific institution. Demographic data was not collected to ensure data remained unidentifiable as the stakeholder group was small (n=13). Conclusion: Secondary to trends in antiobesity medication use, an increasing number of surgical patients are presenting for surgery taking antiobesity medications. New FDA approved antiobesity medications pose a unique issue for anesthesia providers. These medications have unique anesthetic implications and interventions, confirming the need for the development of an evidence based CPG to facilitate knowledge, management, and avoidance and/or reduction of adverse outcomes. The CPG was successfully implemented to meet the needs of a specific institution and is not intended to be generalized.

Keyword

antiobesity medication
Anesthesia
Obesity--drug therapy
Perioperative Care
Practice Guideline

Identifier to cite or link to this item

http://hdl.handle.net/10713/13337