Obesity and Alcoholism

Obesity:

The morbidly obese patient is one whose weight is 30% + above the average weight of the general population for their height and sex.

 

¨ Obese patients have decreased life expectancy and increased operative morbidity.

¨ Associations include hypertension and DM.

¨ Perioperative problems include gastric aspiration, DVT, handling and respiratory problems, especially post-operatively.

 

Minor oral surgery in a morbidly obese patient

1. Patient more comfortable in upright position

2. Access to surgical site difficult, owing to enlarged cheeks

3. Dosage of medication may need to be increased

4. Keep in mind the potential of underlying disease when operating on morbidly obese patients

5. Post-op healing may be delayed, with increased risk of infection, particularly in patients with diabetes mellitus

 

 

Chronic Alcoholism

Complications of Alcoholism include:

¨ Liver disease—      fatty liver, hepatitis, cirrhosis

¨ CNS disease—       Wernicke’s encephalopathy, Korsakoff’s syndrome, cortical atrophy

¨ GI disorders—       peptic ulcers and gastric erosions, varices, diarrhoea

¨ Heart disease—     cardiomyopathy

¨ Blood disorder—    macrocytic anaemia, impaired host defenses

 

Minor Oral Surgery in chronic alcoholic patients:

1. Problems associated with alcoholism:

¨              Aggressive behaviour and erratic attendances

¨              Dental neglect

¨              Anaemia— glossitis, angular chelitis, aphthae, candidosis

¨              Increased tendency due to liver disease

¨              Increased incidence of dry socket and osteomyelitis due to impaired host defenses

 

2. Drug interactions

                          GA agents, sedatives and hypnotics (additive effect)

                          Aspirin and other NSAIDs (bleeding)

                          Metronidazole

 

3. Alcoholics are often heavy smokers

 

4. Chlormethiazole helps patients from experiencing withdrawal symptoms during their stay.