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Morbid obesity perioperative care

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https://www.readbyqxmd.com/read/28411866/addressing-the-challenges-of-sleeve-gastrectomy-in-end-stage-renal-disease-analysis-of-100-consecutive-renal-failure-patients
#1
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...
April 12, 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
#2
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...
March 10, 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
#3
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
#4
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
https://www.readbyqxmd.com/read/27989374/functional-quality-of-life-and-neurodevelopmental-outcomes-after-congenital-cardiac-surgery
#5
REVIEW
Megan L Ringle, Gil Wernovsky
Throughout the past few decades, advances in cardiology, neonatal intensive care, and surgical techniques have resulted in a growing cohort of thriving school-aged children with previously lethal complex congenital heart diseases. While survival has increased, there remains significant morbidity following repair including neurodevelopmental sequelae. Compared to children with a structurally normal heart, these infants and children have a higher frequency of abnormalities in tone, feeding, and delayed developmental milestones, as well as challenges with speech and learning disabilities, while a higher proportion of adolescents suffer from problems with processing speed, executive function, and a unique set of medical hardships related to exercise intolerance and obesity, medication burden, and mental health comorbidities...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27956112/risk-factors-for-complications-of-laparoscopic-sleeve-gastrectomy-and-laparoscopic-roux-en-y-gastric-bypass
#6
Piotr Major, Michał Wysocki, Michał Pędziwiatr, Magdalena Pisarska, Jadwiga Dworak, Piotr Małczak, Andrzej Budzyński
BACKGROUND: Although bariatric procedures are considered safe, yet still they involve a risk of possible perioperative complications. Identification of risk factors for complications would allow for appropriate preoperative optimization of the patient, as well as reasonable postoperative care and early diagnosis and treatment of possible complications. The aim of this study was to determine the risk factors for perioperative complications after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB)...
January 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/27935772/anesthetic-implications-of-obesity-and-obstructive-sleep-apnea
#7
Jennifer Greenwood
The incidence of morbid obesity has tripled within the past 25 years in developed countries, with the highest rate of growth noted among people with body mass index (BMI) greater than 50. The physiologic derangements that accompany obesity affect almost every organ system leading to a vast array of comorbid conditions including obstructive sleep apnea (OSA). This review focuses on the unique perioperative management considerations that the nurse anesthetist must address when caring for these patients as well as the impact of obesity and OSA on postoperative complications and mortality rates...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27837039/low-risk-for-local-and-systemic-complications-after-primary-repair-of-1626-achilles-tendon-ruptures
#8
Nicholas Rensing, Brian R Waterman, Rachel M Frank, Kenneth A Heida, Justin D Orr
INTRODUCTION: Historically, Achilles tendon repairs and other surgeries about the hindfoot have demonstrated a significantly higher rate of wound healing complications and surgical site morbidity. The purpose of this study was to evaluate the comprehensive complication profile and risk factors for adverse short-term, clinical outcomes after primary repair of Achilles tendon ruptures. METHODS: Between the years 2005 and 2014, all cases of primary Achilles tendon repair (Current Procedural Terminology code 27650) entered into the National Surgical Quality Improvement Project (NSQIP) database were extracted for analysis...
November 10, 2016: Foot & Ankle Specialist
https://www.readbyqxmd.com/read/27770262/prior-bariatric-surgery-is-linked-to-improved-colorectal-cancer-surgery-outcomes-and-costs-a-propensity-matched-analysis
#9
Hisham Hussan, Peter P Stanich, Darrell M Gray, Somashekar G Krishna, Kyle Porter, Darwin L Conwell, Steven K Clinton
BACKGROUND: Morbid obesity is associated with worse colorectal cancer (CRC) perioperative outcomes. The impact of bariatric surgery on these outcomes is unknown. METHODS: The National Inpatient Sample Database (2006-2012) was used to identify adults with prior bariatric surgery (divided into BMI ≤35 kg/m(2) and BMI >35 kg/m(2)) or morbid obesity that underwent CRC surgery. Main outcomes were mortality, surgical complications and health care utilization. RESULTS: There were 1813 patients with prior bariatric surgery and 22,552 morbidly obese patients that underwent CRC surgery between 2006 and 2012...
October 21, 2016: Obesity Surgery
https://www.readbyqxmd.com/read/27759743/perioperative-and-periprocedural-airway-management-and-respiratory-safety-for-the-obese-patient-2016-siaarti-consensus
#10
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 (BMI) 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...
December 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27622571/perioperative-care-map-improves-compliance-with-best-practices-for-the-morbidly-obese
#11
Ian Solsky, Alex Edelstein, Michael Brodman, Ronald Kaleya, Meg Rosenblatt, Calie Santana, David L Feldman, Patricia Kischak, Donna Somerville, Santosh Mudiraj, I Michael Leitman, Peter Shamamian
BACKGROUND: Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients. METHODS: A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013...
December 2016: Surgery
https://www.readbyqxmd.com/read/27473800/laparoscopic-sleeve-gastrectomy-surgical-technique-and-perioperative-care
#12
REVIEW
Kellen Hayes, George Eid
Laparoscopic sleeve gastrectomy is a bariatric surgical procedure created for long-term weight loss and improvement of metabolic syndrome abnormalities in morbidly obese patients. It has been shown to demonstrate durable results compared with other bariatric procedures. This article aims to describe the surgical technique and perioperative care for patients undergoing laparoscopic sleeve gastrectomy based on current scientific literature and best standard practices.
August 2016: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27347785/does-bmi-influence-hospital-stay-and-morbidity-after-fast-track-hip-and-knee-arthroplasty
#13
Henrik Husted, Christoffer C Jørgensen, Kirill Gromov, Henrik Kehlet
Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting...
October 2016: Acta Orthopaedica
https://www.readbyqxmd.com/read/27101501/perioperative-respiratory-adverse-events-in-pediatric-ambulatory-anesthesia-development-and-validation-of-a-risk-prediction-tool
#14
Rajeev Subramanyam, Samrat Yeramaneni, Mohamed Monir Hossain, Amy M Anneken, Anna M Varughese
BACKGROUND: Perioperative respiratory adverse events (PRAEs) are the most common cause of serious adverse events in children receiving anesthesia. Our primary aim of this study was to develop and validate a risk prediction tool for the occurrence of PRAE from the onset of anesthesia induction until discharge from the postanesthesia care unit in children younger than 18 years undergoing elective ambulatory anesthesia for surgery and radiology. The incidence of PRAE was studied. METHODS: We analyzed data from 19,059 patients from our department's quality improvement database...
May 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27049191/preventing-hospital-readmissions-and-limiting-the-complications-associated-with-total-joint-arthroplasty
#15
Stephen Yu, Kevin L Garvin, William L Healy, Vincent D Pellegrini, Richard Iorio
Total joint arthroplasty is a highly successful surgical procedure for patients who have painful arthritic joints. The increasing prevalence of total joint arthroplasty is generating substantial expenditures in the American healthcare system. Healthcare payers, specifically the Centers for Medicare and Medicaid Services, currently target total joint arthroplasty as an area for healthcare cost-savings initiatives, which has resulted in increased scrutiny surrounding orthopaedic care, health resource utilization, and hospital readmissions...
2016: Instructional Course Lectures
https://www.readbyqxmd.com/read/26948450/perioperative-noninvasive-ventilation-in-obese-patients-a-qualitative-review-and-meta-analysis
#16
REVIEW
Michele Carron, Francesco Zarantonello, Paola Tellaroli, Carlo Ori
BACKGROUND: Perioperative noninvasive ventilation (NIV) has been proposed to reduce postoperative morbidity and improve perioperative outcomes in patients undergoing general anesthesia. Whether it is advantageous to apply NIV just before and after general anesthesia in obese patients has not been yet established. OBJECTIVES: To perform a qualitative review and meta-analysis to assess the effectiveness and tolerability of perioperative NIV in obese patients. METHODS: All studies in English language performed in clinical setting that compared the application of NIV with standard care just before and after induction of general anesthesia in obese adults (body mass index [BMI]≥35 kg/m(2)) were included...
March 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/26804322/anesthetic-considerations-for-patients-with-bardet-biedl-syndrome-a-case-series-and-review-of-the-literature
#17
Bradford B Smith, David W Barbara, Joseph A Hyder, Mark M Smith
BACKGROUND: Bardet-Biedl syndrome (BBS) is a rare genetic condition with manifestations that can impact anesthetic and perioperative care. There is a void of literature describing the perioperative anesthetic management in this complex patient population. OBJECTIVES: The purpose of this retrospective series was to describe the perioperative care of patients diagnosed with BBS at a large academic tertiary referral center with experience in caring for these patients...
April 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/26658175/are-morbidly-obese-patients-suitable-for-ambulatory-surgery
#18
REVIEW
Tiffany Sun Moon, Girish P Joshi
PURPOSE OF REVIEW: The incidence of morbid obesity continues to increase worldwide. Associated comorbidities, particularly obstructive sleep apnea, increase the perioperative morbidity for this group of patients. The purpose of this review is to discuss appropriate selection of morbidly obese patients for ambulatory surgery. RECENT FINDINGS: Patients with BMI <40 kg/m can safely undergo ambulatory surgery, provided their comorbidities are optimized before surgery...
February 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/26645489/bariatric-surgery-in-1119-patients-with-preoperative-body-mass-index-35-kg-m-2-results-at-1-year
#19
Cristóbal Maiz, Juan Alvarado, Nicolás Quezada, José Salinas, Ricardo Funke, Camilo Boza
BACKGROUND: The use of body mass index (BMI) as the only criterion to indicate bariatric surgery is currently under discussion. There is growing evidence that supports bariatric surgery in carefully selected patients with lower BMI. OBJECTIVES: To report our experience in bariatric surgery in>1000 patients with BMI<35 kg/m(2) and their results at 1 year. SETTING: University hospital (censored). METHODS: A retrospective analysis was performed in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG) with preoperative BMI<35 kg/m(2) from January 2008 to December 2011...
September 2015: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/26537879/negative-pressure-wound-therapy-for-high-risk-wounds-in-lower-extremity-revascularization-study-protocol-for-a-randomized-controlled-trial
#20
RANDOMIZED CONTROLLED TRIAL
Patrick Murphy, Kevin Lee, Luc Dubois, Guy DeRose, Thomas Forbes, Adam Power
BACKGROUND: Rates of surgical site infections (SSIs) following groin incision for femoral artery exposure are much higher than expected of a clean operation. The morbidity and mortality is high, particularly with the use of prosthetic grafts. The vascular surgery population is at an increased risk of SSIs related to peripheral vascular disease (PVD), diabetes, obesity, previous surgery and presence of tissue loss. Negative pressure wound therapy (NPWT) dressings have been used on primarily closed incisions to reduce surgical site infections in other surgical disciplines...
November 4, 2015: Trials
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