![]() ![]() Instruct the patient to have a thorough shower or bath using soap and hot water to wash all the skin folds the evening before and the morning of the procedure. Multiple and thorough applications of antiseptic solutions on the skin in between the folds is necessary to reduce incidence of infection. Ī third physical challenge in placement of the spinal cord stimulator leads in the morbidly obese patients has to do with the patients' skin. The use of specialty bariatric operating tables may be required, as long the use of fluoroscopic imaging is not precluded. Weight of the patient cannot exceed the maximum allowable limit of the procedure table. Encourage the patient to lay prone daily for 15 minutes and to increase in increments the time by 15 minutes daily. Once it is determined that the patient is going to proceed with a spinal cord stimulation procedure, encourage them to try to lay prone and supine daily to increase the duration prior to the surgery date. A great majority of such patients have not attempted to lay prone in years. Breathing may further decrease secondary to sinus congestion. There is also aortocaval compression, which might decrease the overall cardiac output. PHYSICAL CHALLENGES TO SPINAL CORD STIMULATOR LEAD PLACEMENTįirstly, can the patient lie prone for one to two hours? Due to the obese abdomen, the tidal volume and functional residual capacity (FRC) are reduced in the prone position. Compared to women with BMI of lower than 25 kg/m2, those with BMI of 30 kg/m2 or higher were 1.5 times more likely to have symptoms of intervertebral disk herniation. Anyone more than 100 pounds overweight is considered morbidly obese.īoth men and women with BMI of 30 kg/m2 or higher were twice as likely to have difficulties in performing a range of basic daily physical activities.Anyone with a BMI greater than or equal to 40 is considered extremely obese.Adults with a BMI of 30 to 39.9 are considered obese.These people will not have an increased risk of health problems due to their weight. ![]() Some people in this group, such as athletes, may have a lot of muscle weight, and therefore not as much fat. Since the BMI is an estimate, it is not accurate for all people. Adults with a BMI of 25 to 29.9 are considered overweight.A BMI from 18.5 to 24.9 is considered normal.The BMI estimates your level of body fat based on your height and weight. Įxperts often rely on a formula called the body mass index (BMI) to determine if a person is overweight. Nearly two out of every three adults in the United States is overweight. This paper will present guidelines and insights as to how to best manage these patients during lead placement of spinal cord stimulators (SCS). However, these patients present a unique set of both physical and technical challenges to the clinician. The use of spinal cord stimulation offers a long term solution for management of these patients. Increasing rates of obesity in both Western and developing countries result in rising patient populations referred for chronic pain management.
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