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Anesthesia obesity

Joyce C Zhang, John Matelski, Rajiv Gandhi, Timothy Jackson, David Urbach, Peter Cram
BACKGROUND: The "obesity paradox" is a phenomenon described in prior research in which patients who are obese have been shown to have lower postoperative mortality and morbidity compared with normal-weight individuals. The paradox is that clinical experience suggests that obesity is a risk factor for difficult wound healing and adverse cardiovascular outcomes. We suspect that the obesity paradox may reflect selection bias in which only the healthiest patients who are obese are offered surgery, whereas nonobese surgical patients are comprised of both healthy and unhealthy individuals...
February 14, 2018: Clinical Orthopaedics and related Research
Mirko Mihalj, Dajana Vladić, Zoran Karlović, Željka Zadro, Višnja Majerić Kogler
Many papers have been published investigating the effects of intraoperative mechanical ventilation on the incidence of intra- and postoperative respiratory complications. The potential advantages of protective pressure over volume-controlled ventilation mode during laparoscopic surgery have yet to be proven. This study included 60 patients aged between 18 and 70 with ASA score 1-3, body mass index (BMI) ≤35 kg/m2, and without prior history of chronic respiratory diseases, who were scheduled for laparoscopic cholecystectomy under general anesthesia...
September 2017: Acta Clinica Croatica
Seyed Hassan Inanloo, Seyed Reza Yahyazadeh, Samaneh Rashidi, Erfan Amini, Mohammad Reza Nowroozi, Mohsen Ayayti, Hassan Jamshidian, Mohammad Reza Nikoobakht, Seyed Mohammad Kazem Aghamir, Omid Hemmatian, Seyed Ali Momeni
PURPOSE: Percutaneous nephrolithotomy is generally performed under fluoroscopy that is associated with exposure to radiation. Another drawback of fluoroscopic-guided percutaneous nephrolithotomy is the prone position, which is not suitable for all patients. In this study we aimed to evaluate the feasibility, safety and efficacy of ultrasound-guided percutaneous nephrolithotomy in flank position. MATERIALS & METHODS: From December 2010 to July 2016, a total of 603 patients with a mean age of 50...
February 22, 2018: Journal of Urology
Christopher P Childers, Anaar E Siletz, Emily S Singer, Claire Faltermeier, Q Lina Hu, Clifford Y Ko, Gregory J Golladay, Stephen L Kates, Elizabeth C Wick, Melinda Maggard-Gibbons
Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery-a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
P Palumbo, S Usai, C Amatucci, B Perotti, L Ruggeri, G Illuminati, G Tellan
BACKGROUND: The extension of indications for procedures in a Day Surgery (DS) setting has led to changes in the anesthetic and surgical treatment of Inguinal Hernias (IH). According to the recommendations of the European Hernia Society, the treatment of IH in DS units should be performed under Monitored Anesthesia Care (MAC). PATIENTS AND METHODS: 960 patients underwent IH repairs over a period of 24 months. The patients were randomly divided into two groups: R (remifentanil) and F (fentanyl); the group F was considered as a control group...
November 2017: Il Giornale di Chirurgia
Tsigkas Grigorios, Despotopoulos Stefanos, Makris Athanasios, Koniari Ioanna, Armylagos Stylianos, Davlouros Periklis, Hahalis George
Aortic stenosis (AS) is the most common type of valvular heart disease in the elderly. Surgical aortic valve replacement (SAVR) has been the standard practice for treating severe, symptomatic AS, but recently new treatment options have emerged. Transcatheter aortic valve replacement (TAVR) is now an established treatment option in patients at high surgical risk. In this review, we focus on recent developments and compare the two treatment methods in specific populations in terms of efficacy and safety (e.g...
January 2018: Journal of Geriatric Cardiology: JGC
Hassan Soleimanpour, Saeid Safari, Sarvin Sanaie, Mehdi Nazari, Seyed Moayed Alavian
Context: This article discusses the anesthetic considerations in patients undergoing bariatric surgery in the preoperative, intraoperative, and postoperative phases of surgery. Evidence Acquisition: This review includes studies involving obese patients undergoing bariatric surgery. Searches have been conducted in PubMed, MEDLINE, EMBASE, Google Scholar, Scopus, and Cochrane Database of Systematic Review using the terms obese, obesity, bariatric, anesthesia, perioperative, preoperative, perioperative, postoperative, and their combinations...
August 2017: Anesthesiology and Pain Medicine
Waleed Riad, Tarek Ansari, Nanda Shetty
Background: Failed intubation in obstetrics remains the most common cause of death directly related to anesthesia. Neck circumference has been shown to be a predictor for difficult intubation in morbidly obese patients. The aim of this study was to determine an optimal cutoff point of neck circumference for prediction of difficult intubation in obstetric patients. Methods: Ninety-four parturients scheduled for cesarean section under general anesthesia were included in the study...
January 2018: Saudi Journal of Anaesthesia
V A Eley, A Chin, I Tham, J Poh, P Aujla, E Glasgow, H Brown, K Steele, L Webb, A van Zundert
BACKGROUND: Management of labor epidurals in obese women is difficult and extension to surgical anesthesia is not always successful. Our previous retrospective pilot study found epidural extension was more likely to fail in obese women. This study used a prospective cohort to compare the failure rate of epidural extension in obese and non-obese women and to identify risk factors for extension failure. METHODS: One hundred obese participants (Group O, body mass index ≥ 40 kg/m2 ) were prospectively identified and allocated two sequential controls (Group C, body mass index ≤ 30 kg/m2 )...
February 4, 2018: Acta Anaesthesiologica Scandinavica
Jeffrey J Siracuse, Alik Farber, Jeffrey A Kalish, Douglas W Jones, Denis Rybin, Gheorghe Doros, Salvatore T Scali, Marc L Schermerhorn
OBJECTIVE: Endovascular aneurysm repair (EVAR) can be performed through percutaneous or surgical access. Our goal was to assess the difference in perioperative outcomes based on access type in a real-world setting. METHODS: The Vascular Quality Initiative (VQI) database was queried for EVAR. Univariable analysis and multivariable analysis were used to determine the independent effect of access type. RESULTS: There were 8340 (64%) and 4747 (36%) EVAR procedures performed through percutaneous and surgical access (3395 [72%] transverse and 1352 [28%] vertical incisions)...
January 13, 2018: Journal of Vascular Surgery
S B Dowdle, Nicholas A Bedard, Jessell M Owens, Yubo Gao, John J Callaghan
BACKGROUND: Although there are several studies concerning manipulation under anesthesia (MUA) after primary total knee arthroplasty, there is a paucity of literature evaluating MUA after revision total knee arthroplasty (rTKA). The purpose of this study was to determine the incidence, timing, and risk factors associated with MUA after rTKA. METHODS: The Humana database was reviewed from 2007 to 2015 for all patients who underwent rTKA. Patients who underwent rTKA followed by ipsilateral MUA were identified...
December 5, 2017: Journal of Arthroplasty
Zachary C Lum, David A Crawford, Adolph V Lombardi, Jason M Hurst, Michael J Morris, Joanne B Adams, Keith R Berend
BACKGROUND: Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA. METHODS: Six hundred and fifty medial UKA and 1300 TKA were performed in patients with BMI >35kg/m2 (mean 41kg/m2 ) between 2007 and 2012. Pre- and postoperative ROM, Knee Society scores, perioperative factors, complications and reoperations were compared...
January 2018: Knee
Nirav K Patel, Morad Chughtai, Anton Khlopas, Chukwuweike Gwam, Nipun Sodhi, Assem A Sultan, Tanner McGinn, Anil Bhave, Jaydev B Mistry, Ronald E Delanois, Michael A Mont
INTRODUCTION: Knee stiffness following total knee arthroplasty (TKA) is a common complication, especially in obese patients. The initial, non-operative treatments for this complication includes splinting and physical therapy. If these measures fail, manipulation under anesthesia (MUA) or surgical exploration can be considered to restore range of motion (ROM). However, it is generally desirable to avoid these procedures. For these reasons, newer physical therapy protocols have been developed...
December 22, 2017: Surgical Technology International
Nádia Maria da Conceição Duarte, Ana Maria Menezes Caetano, Silvio da Silva Caldas Neto, Getúlio Rodrigues de Oliveira Filho, Gustavo de Oliveira Arouca, Josemberg Marins Campos
BACKGROUND AND OBJECTIVES: The weight parameters for use of sugammadex in morbidly obese patients still need to be defined. METHODS: A prospective clinical trial was conducted with sixty participants with body mass index≥40kg·m-2 during bariatric surgery, randomized into three groups: ideal weight (IW), 20% corrected body weight (CW20) and 40% corrected body weight (CW40). All patients received total intravenous anesthesia. Rocuronium was administered at dose of 0...
January 5, 2018: Revista Brasileira de Anestesiologia
Ramez Philips, Brad deSilva, Laura Matrka
OBJECTIVES/HYPOTHESIS: To assess the feasibility of jet ventilation in obese patients and to compare complications of jet ventilation in obese and nonobese patients. STUDY DESIGN: Retrospective review of medical records. METHODS: We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with jet ventilation between March 2014 and January 2017. Adequacy of jet ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and ventilation...
December 30, 2017: Laryngoscope
Vidya Chidambaran, Anurag Tewari, Mohamed Mahmoud
PURPOSE: Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children...
December 21, 2017: Journal of Clinical Anesthesia
Mikako Hirakawa, Tasuku Nishihara, Kazuo Nakanishi, Sakiko Kitamura, Sonoko Fujii, Keizo Ikemune, Kentaro Dote, Yasushi Takasaki, Toshihiro Yorozuya
RATIONALE: Coffin-Lowry syndrome (CLS) is a rare inherited disease with specific clinical features, such as mental retardation, facial dysmorphism, and cardiac abnormality. In particular, the characteristic facial features of CLS, including retrognathia and large tongue, are associated with difficult ventilation and/or intubation, which is a serious problem of anesthesia management. However, case reports on anesthesia management of CLS are very limited as there are only two published English reports till date...
December 2017: Medicine (Baltimore)
Palmira Santos, Jennifer Gaudet Hefele, Grant Ritter, Jennifer Darden, Cassandra Firneno, Ann Hendrich
OBJECTIVE: To re-examine the risk factors for shoulder dystocia given the increasing rates of obesity and diabetes in pregnant women. DESIGN: Retrospective observational study. SETTING: Five hospitals located in Wisconsin, Florida, Maryland, Michigan, and Alabama. PARTICIPANTS: We evaluated 19,236 births that occurred between April 1, 2011, and July 25, 2013. METHODS: Data were collected from electronic medical records and used to evaluate the risk of shoulder dystocia...
January 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Ronald B George, Dolores M McKeen, Jennifer E Dominguez, Terrence K Allen, Patricia A Doyle, Ashraf S Habib
PURPOSE: Hypotension is common after spinal anesthesia for Cesarean delivery. It is associated with nausea, vomiting, and fetal acidosis. Previous research on phenylephrine excluded obese subjects. We compared the incidence of intraoperative nausea and vomiting (IONV) in obese patients who received a prophylactic phenylephrine infusion vs those who received bolus dosing for the treatment of spinal-induced hypotension. METHODS: In this multicentre, double-blinded randomized controlled trial, 160 obese women undergoing elective Cesarean delivery under spinal anesthesia were randomized to receive a prophylactic phenylephrine infusion initiated at 50 μg·min-1 (and titrated according to a predefined algorithm) or 100 μg phenylephrine boluses to treat hypotension...
March 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Warwick D Ngan Kee
No abstract text is available yet for this article.
March 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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