Pediatric Anesthesia- BMI cutoff

[Hoebo54]

For the Pediatric guys/gals:

What is your BMI cutoff for an outpatient surgery center that does bread/butter ENT( BMT, T&A, FESS, septoplasty etc)?? Down here in the land of lard and biscuits ( AKA Georgia) the frequency of morbidly obese kids blows my mind. Some literature references 95%-99% percentile for weight base on age but that's not really practical to calculate. There no consensus that I found ,but I'm at a hard cutoff at 30. What does everyone else do??

---

Members don't see this ad.

 

[Straight2eight]

For the Pediatric guys/gals:

What is your BMI cutoff for an outpatient surgery center that does bread/butter ENT( BMT, T&A, FESS, septoplasty etc)?? Down here in the land of lard and biscuits ( AKA Georgia) the frequency of morbidly obese kids blows my mind. Some literature references 95%-99% percentile for weight base on age but that's not really practical to calculate. There no consensus that I found ,but I'm at a hard cutoff at 30. What does everyone else do??

According to ENT society guidelines T&A with BMI >= 95% needs to have a sleep study showing only mild or moderate OSA or else be admitted for observation post-op. Strict BMI in kids is not easily relatable to adult measurements (4 y/o boy with BMI 20 is quite obese). Percentiles are easy to calculate, not sure what you meant by not practical. All other procedures there is limited evidence of increased respiratory complications but if the kid is particularly obese and is going to need some definite post-op narcotics I might throw a flag.

Edit: sorry I think I was thinking of the implications of OSA on its own for respiratory complications. Ignore the last thing I said about limited evidence.

You could consider a cut-off of >99% though that includes a lot of patients. A better alternative to a BMI cut off would be to pick a BMI z-score cut off.

 

[IlDestriero]

99th percentile.

 

[Hoebo54]

Our ancillary staff have hard enough time doing accurate BMIs and are pulled from our EMR. I'm trying to dumb it down and not have them calculate the percentage. Maybe the BMI with z score