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Morbid obesity perioperative care

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https://www.readbyqxmd.com/read/29232296/morbid-obesity-does-not-increase-morbidity-or-mortality-in-robotic-cardiac-surgery
#1
Hiroto Kitahara, Brooke Patel, Mackenzie McCrorey, Sarah Nisivaco, Husam H Balkhy
OBJECTIVE: Morbid obesity (body mass index ≥ 35 kg/m) usually confers a higher perioperative risk in cardiac surgery. Robotic cardiac surgery may have many advantages for these high-risk patients. METHODS: We retrospectively reviewed patients undergoing robotic cardiac surgery from July 2013 to April 2017 at our institution. We compared the outcomes of morbidly obese patients versus nonobese patients. RESULTS: A total of 486 patients underwent robotic cardiac surgery (322 men, median age = 65 years)...
December 7, 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29212336/-new-directions-in-bariatric-and-metabolic-surgery
#2
Martin Fried
Czech Republic may be counted among the leading European Countries in regards of the level of delivered high quality multidisciplinary care in treatment of obesity and obesity related metabolic diseases. The 1st Faculty of Medicine (Charles University) and the Faculty General Hospital in Prague played the most important role in the development of bariatric and metabolic surgery in the Czech Republic. pCzech bariatric surgery achieves great successes both on national and international levels. Just to mention some of them: M...
2017: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/29195738/a-perioperative-care-map-improves-outcomes-in-patients-with-morbid-obesity-undergoing-major-surgery
#3
Benjamin D Boodaie, Anthony H Bui, David L Feldman, Michael Brodman, Peter Shamamian, Ronald Kaleya, Meg Rosenblatt, Donna Somerville, Patricia Kischak, I Michael Leitman
BACKGROUND: The surgical management of patients with morbid obesity (BMI ≥ 40) is notable for a relatively high risk of complications. To address this problem, a perioperative care map was developed using precautions and best practices commonly employed in bariatric surgery. It requires additional medical assessments, sleep apnea surveillance, more stringent guidelines for anesthetic management, and readily available bariatric operating room equipment, among other items. This care map was implemented in 2013 at four major urban teaching hospitals for use in patients undergoing all types of non-ambulatory surgery with a BMI greater than 40 kg/m2...
November 28, 2017: Surgery
https://www.readbyqxmd.com/read/29114413/perioperative-factors-affecting-ambulatory-outcomes-following-laparoscopic-adjustable-gastric-banding
#4
Mirsad Dupanovic, Ron Krebill, Iris Dupanovic, John Nachtigal, Melissa Rockford, Walter Orr
Objective: Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes. Methods: Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed...
October 2017: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/29077813/death-or-near-death-in-patients-with-obstructive-sleep-apnoea-a-compendium-of-case-reports-of-critical-complications
#5
Y Subramani, M Nagappa, J Wong, J Patra, F Chung
The care of surgical patients with obstructive sleep apnoea (OSA) invokes concerns with safety and liability because of the risk that exists for perioperative death or near-death. The purpose of this review is to analyse the available literature to identify risk factors for perioperative critical complications in patients with OSA. Literature reports were screened for life threatening complications and deaths in surgical patients with OSA. The critical complications were sub-grouped as death/near-death events (death and anoxic brain damage) vs critical respiratory events (CRE)/other events and analysed for various risk factors...
November 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29064879/the-successful-implementation-of-a-modified-enhanced-recovery-after-surgery-eras-program-for-bariatric-surgery-in-a-south-african-teaching-hospital
#6
Emil Loots, Benn Sartorius, Imran M Paruk, Damian L Clarke
BACKGROUND: This study assessed the impact of strict adherence to perioperative pathways incorporating an enhanced recovery after surgery protocol on the outcomes of bariatric surgery at our center. METHODS: Prospective data were collected on 62 patients undergoing bariatric surgery between January 2011 and March 2016. Outcomes were compared between those who adhered to the perioperative pathway and those who did not. RESULTS: Fifty-three patients underwent laparoscopic sleeve gastrectomy, and 9 patients underwent Laparoscopic Roux-en-Y Gastric Bypass...
October 23, 2017: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/29062439/problems-in-bariatric-patient-care-challenges-for-dieticians
#7
REVIEW
Małgorzata Kostecka, Monika Bojanowska
Obesity management options include a low-calorie diet, behavioral therapy, regular physical activity and pharmacological therapy. However, treatment failure is frequently encountered, most of these methods are ineffective, and a positive outcome is rarely maintained in the long term. In morbidly obese patients, bariatric surgery is considered the most effective treatment for obesity as well as the accompanying diseases. Bariatric surgery promotes much greater weight loss than conservative treatment, regardless of the applied surgical technique...
September 2017: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
https://www.readbyqxmd.com/read/29049219/risk-assessment-of-morbidly-obese-parturient-in-cesarean-section-delivery-a-prospective-cohort-single-center-study
#8
Xiaohu An, Yanhong Zhao, Ying Zhang, Qiling Yang, Yilong Wang, Weiwei Cheng, Zeyong Yang
BACKGROUND: Up to 40% of women gain excessive weight during pregnancy. Obesity complications and risks in parturient women undergoing cesarean section (CS) with different anesthetic methods remain unknown. This study aimed to assess the safety and risk of obese women undergoing CS delivery with various perioperative anesthetic methods. METHODS: Seven hundred ninety parturient women underwent CS under general anesthesia (GA), intraspinal anesthesia including epidural anesthesia (EA) and combined spinal-epidural anesthesia (CSEA)...
October 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28951657/sleeve-gastrectomy-and-left-ventricular-assist-device-for-heart-transplant
#9
Joseph Greene, Tung Tran, Timothy Shope
BACKGROUND AND OBJECTIVES: Heart failure (HF) is a severe obesity-related comorbidity. Many patients with end-stage HF eventually require cardiac transplantation for long-term survival. These patients may be precluded from enrollment in heart transplant programs secondary to morbid obesity. We propose a pathway involving sleeve gastrectomy (SG) for patients with morbid obesity and HF to afford cardiac transplantation eligibility. METHODS: Three patients with HF and morbid obesity underwent implantation of a left ventricular assist device (LVAD) and SG at an academic tertiary care institution in Washington, DC...
July 2017: JSLS: Journal of the Society of Laparoendoscopic Surgeons
https://www.readbyqxmd.com/read/28901992/european-guidelines-on-perioperative-venous-thromboembolism-prophylaxis-surgery-in-the-elderly
#10
Sibylle Kozek-Langenecker, Christian Fenger-Eriksen, Emmanuel Thienpont, Giedrius Barauskas
: The risk for postoperative venous thromboembolism (VTE) is increased in patients aged more than 70 years and in elderly patients presenting with co-morbidities, for example cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks and sustained perioperative thromboprophylaxis are essential in this patient population. Timing and dosing of pharmacoprophylaxis may be adopted from the non-aged population. Direct oral anti-coagulants are effective and well tolerated in the elderly; statins may not replace pharmacological thromboprophylaxis...
September 9, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28866313/impact-of-super-obesity-on-perioperative-outcomes-after-hepatectomy-the-weight-of-the-risk
#11
Luis F Acosta, Catherine R Garcia, Adam Dugan, Francesc Marti, Daniel Davenport, Roberto Gedaly
BACKGROUND: We evaluated perioperative outcomes in super obese patients (body mass index >50 kg/m(2)) undergoing liver resection using the American College of Surgeons National Surgical Quality Improvement Program. METHODS: Patients undergoing hepatectomy recorded in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2015 were analyzed. Out of 21,228 hepatectomies in the National Surgical Quality Improvement Program dataset, 146 were performed on super obese patients...
November 2017: Surgery
https://www.readbyqxmd.com/read/28833518/post-sternotomy-mediastinitis-in-the-modern-era
#12
Siew S C Goh
BACKGROUND: Post-sternotomy mediastinitis is associated with significant mortality and morbidity. Despite surgical advances in cardiac surgery and improvements in perioperative care, mediastinitis remains a devastating post-operative complication. This study provides a comprehension review of post-sternotomy mediastinitis in the modern era, and discusses the incidence, risk factors, microbiology, prevention, and management of this complication. METHODS: This review was based on a PubMed/MEDLINE literature search up until 9th March 2017 for publications relevant to mediastinitis post-cardiac surgery...
September 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28817167/body-mass-index-50-kg-m2-and-beyond-perioperative-care-of-pregnant-women-with-superobesity-undergoing-cesarean-delivery
#13
Marcela Carolina Smid, Sarah K Dotters-Katz, Robert M Silver, Jeffrey A Kuller
Importance: Superobesity, defined as body mass index 50 kg/m(2) or greater, is the fastest-growing obesity group in the United States. Currently, 2% of pregnant women in the United States are superobese, and 50% will deliver via cesarean delivery. Objective: To review evidence of perioperative care during cesarean delivery among superobese women. Evidence Acquisition: We performed an evidence-based review of maternal and neonatal risks of cesarean delivery and of intraoperative management and immediate postpartum care of superobese pregnant women...
August 2017: Obstetrical & Gynecological Survey
https://www.readbyqxmd.com/read/28767803/perioperative-care-in-bariatric-surgery-in-the-context-of-the-acerto-project-reality-versus-surgeons-assumptions-in-a-cuiab%C3%A3-hospital
#14
Jacqueline Jéssica De-Marchi, Mardem Machado De-Souza, Alberto Bicudo Salomão, José Eduardo de Aguilar Nascimento, Anyelle Almada Selleti, Erik de-Albuquerque, Katia Bezerra Veloso Mendes
Objective: to assess the level of knowledge among bariatric surgeons, about the recommendations of the ACERTO Project, correlating their assumptions on their perioperative prescriptions and the reality, according to the patients charts. Method: we conducted a prospective, longitudinal, observational study comparing the assumptions of bariatric surgeons obtained through responses on a specific questionnaire with the reality found in clinical data from the hospital records...
May 2017: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28482650/obesity-and-perioperative-noninvasive-ventilation-in-bariatric-surgery
#15
Michele Carron, Francesco Zarantonello, Giovanna Ieppariello, Carlo Ori
The incidence and prevalence of obesity continues to increase globally. Physicians will therefore provide care for an increasing number of obese patients in their clinical practice. Optimal management of these patients is required to minimize the risk of perioperative complications that increase morbidity and mortality. Obesity affects the respiratory function. It is generally associated with reduced lung volume with increased atelectasis, decreased lung and chest wall compliance, increased airway resistance, and moderate to severe hypoxemia...
June 2017: Minerva Chirurgica
https://www.readbyqxmd.com/read/28445566/variation-in-outcomes-at-bariatric-surgery-centers-of-excellence
#16
Andrew M Ibrahim, Amir A Ghaferi, Jyothi R Thumma, Justin B Dimick
Importance: In the United States, reports about perioperative complications associated with bariatric surgery led to the establishment of accreditation criteria for bariatric centers of excellence and many bariatric centers obtaining accreditation. Currently, most bariatric procedures occur at these centers, but to what extent they uniformly provide high-quality care remains unknown. Objective: To describe the variation in surgical outcomes across bariatric centers of excellence and the geographic availability of high-quality centers...
July 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28411866/addressing-the-challenges-of-sleeve-gastrectomy-in-end-stage-renal-disease-analysis-of-100-consecutive-renal-failure-patients
#17
Young Kim, Junzi Shi, Christopher M Freeman, Andrew D Jung, Vikrom K Dhar, Shimul A Shah, E Steve Woodle, Tayyab S Diwan
BACKGROUND: While previous studies have demonstrated short-term efficacy of laparoscopic sleeve gastrectomy in candidates awaiting renal transplantation, the combination of morbid obesity and end-stage renal disease presents unique challenges to perioperative care. We demonstrate how increasing experience and the development of postoperative care guidelines can improve outcomes in this high-risk population. METHODS: Single-center medical records were reviewed for renal transplantation candidates undergoing laparoscopic sleeve gastrectomy between 2011 and 2015 by a single surgeon...
August 2017: Surgery
https://www.readbyqxmd.com/read/28396128/perioperative-analgesic-profile-of-dexmedetomidine-infusions-in-morbidly-obese-undergoing-bariatric-surgery-a-meta-analysis-and-trial-sequential-analysis
#18
Preet Mohinder Singh, Rajesh Panwar, Anuradha Borle, Jan P Mulier, Ashish Sinha, Basavana Goudra
BACKGROUND: Opioid-sparing analgesia for bariatric surgery in morbidly obese can potentially prevent catastrophic airway complications. Our meta-analysis attempts to consolidate the evidence on dexmedetomidine evaluating its analgesic and safety profile. METHODS: Trails comparing perioperative dexmedetomidine infusion to conventional analgesic regimens for bariatric surgery were searched. Comparisons were made for 24-hour and postanesthesia care unit (PACU) morphine consumed, PACU pain scores, postoperative nausea and vomiting pain scores, and heartrate...
August 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28298280/nutritional-recommendations-for-adult-bariatric-surgery-patients-clinical-practice
#19
REVIEW
Shiri Sherf Dagan, Ariela Goldenshluger, Inbal Globus, Chaya Schweiger, Yafit Kessler, Galit Kowen Sandbank, Tair Ben-Porat, Tali Sinai
Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up...
March 2017: Advances in Nutrition
https://www.readbyqxmd.com/read/28248604/middle-ear-obliteration-with-blind-sac-closure-of-the-external-auditory-canal-for-spontaneous-csf-otorrhea
#20
Shawn M Stevens, Ryan Crane, Myles L Pensak, Ravi N Samy
Outcome Objectives To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2 groups based on the surgery performed: (1) 11 patients underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal and (2) 26 patients underwent other procedures...
March 2017: Otolaryngology—Head and Neck Surgery
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