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Anesthesia bariatric surgery

Flavia Petrini, Ida Di Giacinto, Rita Cataldo, Clelia Esposito, Vittorio Pavoni, Paolo Donato, Antonella Trolio, Guido Merli, Massimiliano Sorbello, Paolo Pelosi
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose body mass index is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population...
October 19, 2016: Minerva Anestesiologica
Roman Schumann, Andrzej P Kwater, Iwona Bonney, Diane Ladd, Julie Kim, Anupriya Gupta, Sam D Gumbert, Evan G Pivalizza
STUDY OBJECTIVE: To evaluate use of a respiratory volume monitor (RVM; ExSpiron, Respiratory Motion, Inc., Waltham, MA, USA) that provides minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) measurements in obese surgical patients, hitherto undescribed. DESIGN: Prospective, IRB-approved observational study of RVM parameter accuracy in obese surgical patients, designed to test the ability of the RVM to detect predefined postoperative respiratory depression (PORD) and apneic events (POA) and to correlate STOP-Bang scores with PORD and POA...
November 2016: Journal of Clinical Anesthesia
Mordechai Shimonov, Pinhas Schechter, Mona Boaz, Ronen Waintrob, Tiberiu Ezri
BACKGROUND: The effect of body mass index (BMI) reduction following bariatric surgery on subsequent airway management has not been investigated. This study aimed to investigate the association between BMI reduction and airway assessment and management measured by Mallampati class (MC) and laryngoscopy grade (LG). METHODS: We conducted a retrospective study over 6 years to compare the BMI changes, MC and LG in patients having weight reduction bariatric surgery followed by subsequent surgery...
August 29, 2016: Obesity Surgery
Vlad V Simianu, Jonathan G Sham, Andrew S Wright, Skye D Stewart, Mouhamad Alloosh, Michael Sturek, David E Cummings, David R Flum
BACKGROUND: The impact of Roux-en-Y gastric bypass (RYGB) on type 2 diabetes mellitus is thought to result from upper and/or lower gut hormone alterations. Evidence supporting these mechanisms is incomplete, in part because of limitations in relevant bariatric-surgery animal models, specifically the lack of naturally insulin-resistant large animals. With overfeeding, Ossabaw swine develop a robust metabolic syndrome, and may be suitable for studying post-surgical physiology. Whether bariatric surgery is feasible in these animals with acceptable survival is unknown...
August 2015: Surgical Science
Sebastian Zaremba, Christina H Shin, Matthew M Hutter, Sanjana A Malviya, Stephanie D Grabitz, Teresa MacDonald, Daniel Diaz-Gil, Satya Krishna Ramachandran, Dean Hess, Atul Malhotra, Matthias Eikermann
BACKGROUND: Bariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression. METHODS: In a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O)...
July 2016: Anesthesiology
Vassilios Tassoudis, Hronis Ieropoulos, Menelaos Karanikolas, George Vretzakis, Aik Bouzia, Elias Mantoudis, Argyro Petsiti
BACKGROUND: Existing data suggest that obesity correlates with airway hyper-reactivity. However, the incidence of bronchospasm during bariatric surgery in obese patients has not been well studied. METHODS: This was a prospective observational study comparing 50 obese versus 50 non obese patients undergoing elective laparoscopic surgery over a 2 year period. Bronchospasm was detected clinically by auscultation and was confirmed by measuring peak airway pressure during mechanical ventilation...
2016: SpringerPlus
Paola Aceto, Carlo Lai, Valter Perilli, Teresa Sacco, Cristina Modesti, Marco Raffaelli, Liliana Sollazzi
BACKGROUND: Previous studies performed in non-obese patients undergoing elective surgery have revealed that psychological factors may affect postoperative analgesic requirements. The aim of this observational prospective study was to investigate the extent to which psychopathological dimensions, including anxiety, depression and alexithymia, may influence postoperative pain intensity and analgesics consumption using patient-controlled analgesia (PCA) in patients undergoing bariatric surgery...
September 1, 2016: Physiology & Behavior
Maciej Matłok, Piotr Major, Piotr Małczak, Michał Wysocki, Leif Hynnekleiv, Mateusz Nowak, Konrad Karcz, Michał Pędziwiatr, Andrzej Budzyński
INTRODUCTION    Obesity is a growing worldwide problem. One of the most effective treatments is a bariatric procedure; however, surgery is associated with the risk of complications, such as staple line leakage, suture line bleeding, and rhabdomyolysis (RML). OBJECTIVES    The objective of our study was to assess the risk of RML after bariatric surgery related to intravenous fluid administration in the perioperative period. PATIENTS AND METHODS    The study involved 194 patients who underwent a bariatric surgery (laparoscopic sleeve gastrectomy or laparoscopic gastric bypass)...
April 13, 2016: Polskie Archiwum Medycyny Wewnętrznej
Paul J Samuels, Matthew D Sjoblom
PURPOSE OF REVIEW: Pediatric obesity has become commonplace in our clinical practice, and presents anesthesia providers with numerous challenges. This study provides an up-to-date review of their perioperative care, including the measurement of pediatric obesity, rational drug dosing in obese children, and recent data on bariatric outcomes in adolescents. RECENT FINDINGS: Pediatric obesity is associated with a number of relevant comorbidities that impact anesthesia care, and specific children are at particularly high risk...
June 2016: Current Opinion in Anaesthesiology
Tomoyuki Saito
Perioperative pulmonary aspiration is an infrequent but is still a leading cause of anesthesia-related morbidity and mortality. This article reviews risk factors of perioperative pulmonary aspiration related to anesthesia, devices and operation. The most consistent risk factors related to anesthesia are light anesthesia, residual neuromuscular blockade after anesthesia, intermittent positive pressure ventilation particularly with high airway pressure, and prolonged anesthesia. The presence of a supraglottic airway inserted in hypopharynx, multiattempts at tracheal intubation, incorrectly inserted airway, the classic laryngeal mask, airway removal and cuff deflation during recovery of anesthesia, and exchange to a tracheal tube from supraglottic airway increase the risk of aspiration and regurgitation...
January 2016: Masui. the Japanese Journal of Anesthesiology
Kate Reed, Martino F Pengo, Joerg Steier
BACKGROUND: Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing frequently associated with obesity. Obese subjects undergoing elective surgical procedures with general anesthesia are potentially at risk if this condition is not identified. Our aim was to assess the prevalence of bariatric patients with undiagnosed OSA following pre-operative assessment and who could benefit from peri-procedural respiratory management. METHODS: Patients who were referred for prospective bariatric surgery were screened using the STOP-BANG questionnaire...
February 2016: Journal of Thoracic Disease
Fabio Consiglio, Roberto Pizzamiglio, Pier Camillo Parodi, Fabrizio De Biasio, Pier Nicola Machin, Carla Di Loreto, Mabel Gamboa
BACKGROUND: Silhouette Sutures (Kolster Methods, Inc., Corona, CA) exhibit different biological characteristics at various time points after their placement. OBJECTIVES: The goals of this study were to understand the biological reactions of Silhouette Sutures in human tissues at different time intervals and to determine the index of resistance of the sutures in subcutaneous tissue. METHODS: Histologic examination was performed on section soft tissue containing the sutures at 1 month, 3 months, 6 months, and 1 year after suture placement...
March 2016: Aesthetic Surgery Journal
Salvatore Tolone, Vincenzo Pilone, Mario Musella, Gianluca Rossetti, Marco Milone, Landino Fei, Pietro Forestieri, Ludovico Docimo
BACKGROUND: At present, prospectively collected data on rhabdomyolysis (RML) after bariatric surgery are limited. OBJECTIVES: To evaluate the incidence, risk factors, and therapeutic strategy of RML in different bariatric procedures. SETTING: University hospitals, Italy. METHODS: Obese patients were prospectively enrolled. Preoperative demographic characteristics and clinical data, as well as type of anesthesia and type and total duration of surgery, were recorded as potential risk factors for RML...
February 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Mohamed M Ghoneim, Michael W O'Hara
BACKGROUND: The interaction of depression and anesthesia and surgery may result in significant increases in morbidity and mortality of patients. Major depressive disorder is a frequent complication of surgery, which may lead to further morbidity and mortality. LITERATURE SEARCH: Several electronic data bases, including PubMed, were searched pairing "depression" with surgery, postoperative complications, postoperative cognitive impairment, cognition disorder, intensive care unit, mild cognitive impairment and Alzheimer's disease...
2016: BMC Surgery
Sami Abu-Halaweh, Firas Obeidat, Anthony R Absalom, Abdelkareem AlOweidi, Mahmood Abu Abeeleh, Ibrahim Qudaisat, Fay Robinson, Keira P Mason
INTRODUCTION: The primary aim of this pilot study was to determine whether the dexmedetomidine infusion initiated immediately after laparoscopic bariatric surgery, offers an advantage over a morphine infusion with respect to rescue morphine and paracetamol requirements over the first 24 post-operative hours. METHODS: Sixty morbidly obese adult patients scheduled for laparoscopic bariatric surgery were randomly assigned to receive an infusion of either 0.3 mcg/kg/h dexmedetomidine (Group D) or 3 mg/h Morphine (Group M) for 24 h immediately post-operatively...
August 2016: Surgical Endoscopy
Monika Proczko, Lukasz Kaska, Pawel Twardowski, Pieter Stepaniak
While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction of anesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery...
February 2016: Journal of Anesthesia
Eliana C M Sudré, Priscila R de Batista, Yara M M Castiglia
BACKGROUND: We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. METHODS: We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine)...
November 2015: Obesity Surgery
Daniela Xará, Júlia Mendonça, Helder Pereira, Alice Santos, Fernando José Abelha
INTRODUCTION: Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia. METHODS: This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011...
September 2015: Revista Brasileira de Anestesiologia
Daniela Xará, Júlia Mendonça, Helder Pereira, Alice Santos, Fernando José Abelha
INTRODUCTION: Patients with STOP-BANG score >3 have a high risk of Obstructive sleep apnea. The aim of this study was to evaluate early postoperative respiratory complications in adults with STOP-BANG score >3 after general anesthesia. METHODS: This is a prospective double cohort study matching 59 pairs of adult patients with STOP-BANG score >3 (high risk of obstructive sleep apnea) and patients with STOP-BANG score <3 (low risk of obstructive sleep apnea), similar with respect to gender, age and type of surgery, admitted after elective surgery in the Post-Anaesthesia Care Unit in May 2011...
September 2015: Brazilian Journal of Anesthesiology
Janelle D Vaughns, Victoria C Ziesenitz, John N van den Anker
Obesity represents one of the most important public health issues according to the World Health Organization. Additionally, in a recent National Health and Nutrition Survey of 2011-2012, approximately 17 % of children and adolescents in the United States were considered obese. The obesity rate is higher within the adolescent age group as compared to preschool children. Childhood obesity is particularly problematic, because the co-morbid disease states which accompany obesity may require frequent pharmacotherapy and/ or surgical intervention...
2015: Current Pharmaceutical Design
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