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Obesity, anesthesia

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
J Ulrici, G Hempel, M Sasse, J Vollrath, C Höhne
BACKGROUND: Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is a relevant problem in Germany. METHODS: From October 2008 until August 2009, at the university clinic in Leipzig, 504 in- and outpatients, aged 2-18 years, ASA I-III, undergoing elective procedures (ENT and pediatric surgery), were observed...
October 10, 2016: Der Anaesthesist
Parmida Beigi, Paul Malenfant, Abtin Rasoulian, Robert Rohling, Alison Dube, Vit Gunka
Current 2-D ultrasound technology is unable to perform a midline neuraxial needle insertion under real-time ultrasound guidance using a standard needle and without an assistant. The aim of the work described here was to determine the feasibility of a new technology providing such capability, starting with a study evaluating the selected puncture site. A novel 3-D ultrasound imaging technique was designed using thick-slice rendering in conjunction with a custom needle guide (3DUS + Epiguide). A clinical feasibility study evaluated the ability of 3DUS + Epiguide to identify the epidural needle puncture site for a midline insertion in the lumbar spine...
October 6, 2016: Ultrasound in Medicine & Biology
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
Pengcheng Xie, Zhanfang Li, Zhongyi Tian
OBJECTIVE: Pulmonary dysfunction after laparoscopic surgery is commonly seen in the high-risk group of obese patients. To reduce or avoid this complication caused by an improper combination of mechanical ventilation parameters, we conducted the following trial of 3 factors with 3 levels of mechanical ventilation, aimed to obtain the low airway pressure with good ventilator effects. METHODS: Patients were randomly allocated as a sample of cases according to the "30≤weight/height(2)<40" obesity index...
November 2016: Journal of Clinical Anesthesia
Ying-Dong Lian, Zong-Xiang Chen, Kang-Ru Zhu, Shu-Yin Sun, Li-Ping Zhu
OBJECTIVES: The increase in the prevalence of obesity presents a significant health and economic problem. Obesity has been reported to be a major contributor to variety of chronic diseases. Childhood obesity has been rising over the past decades leading to various complications in health. Millions of infants and children undergo surgery every year on various health grounds. The present investigation was undertaken to evaluate the effect of spinal anesthesia of equipotent doses of ropivacaine and bupivacaine on over-weight neonatal rats...
September 26, 2016: Revista Brasileira de Anestesiologia
Thiago Celestino Chulam, Renan Bezerra Lira, Luiz Paulo Kowalski
OBJECTIVE: to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal. METHODS: fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water...
July 2016: Revista do Colégio Brasileiro de Cirurgiões
Luís Gustavo Santos Périssé, Paulo Cézar Marques Périssé Ecbc-Rj, Kelson Ferreira Ribeiro
OBJECTIVE: : to evaluate the thickness of the gastric wall at the time of intra gastric balloon (IGB) placement, at the time of its withdrawal and one month after withdrawal. METHODS: : fifteen morbidly obese patients underwent the introduction of IGB under general anesthesia. In all patients, there was infusion of 500ml of distilled water in the balloon for the test. Measurements of the thickness of the gastric wall were made in the antrum, body and proximal body, using a radial echoendoscope with a frequency of 12MHz and maximum zoom, and its own balloon inflated with 5ml of distilled water...
July 2016: Revista do Colégio Brasileiro de Cirurgiões
Chantal A Boly, Etto C Eringa, R Arthur Bouwman, Rob F P van den Akker, Frances S de Man, Ingrid Schalij, Stephan A Loer, Christa Boer, Charissa E van den Brom
BACKGROUND: While most studies focus on cardiovascular morbidity following anesthesia and surgery in excessive obesity, it is unknown whether these intraoperative cardiovascular alterations also occur in milder forms of adiposity without type 2 diabetes and if insulin is a possible treatment to improve intraoperative myocardial performance. In this experimental study we investigated whether mild adiposity without metabolic alterations is already associated with cardiometabolic dysfunction during anesthesia, mechanical ventilation and surgery and whether these myocardial alterations can be neutralized by intraoperative insulin treatment...
2016: Cardiovascular Diabetology
Andreea L Seritan, Kyoungmi Kim, Ian Benjamin, Ioana Seritan, Randi J Hagerman
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disease with motor, psychiatric, and cognitive manifestations that occurs in carriers of the fragile X mental retardation 1 (FMR1) gene premutations. This was a retrospective chart review of 196 individuals (127 men and 69 women) with FXTAS. Forty-six (23%) participants were cognitively impaired, of whom 19 (10%) had dementia. Risk factors for dementia were examined (CGG repeat size; alcohol, benzodiazepine, and opioid use; diabetes; hyperlipidemia; hypertension; hypothyroidism; obesity; sleep apnea; surgeries with general anesthesia; depression; family history of dementia)...
September 19, 2016: Journal of Geriatric Psychiatry and Neurology
Nilay Boztas, Sermin Oztekin, Sevda Ozkardes, Mert Akan, Sule Ozbilgin, Ayse Baytok
OBJECTIVE: We compared the effects of three different doses of remifentanil infusion, which were performed for the induction of anesthesia in elder patients, on cardiovascular response. RESEARCH DESIGN AND METHODS: The present study was designed as a randomized, prospective and double-blind study. A total of 90 ASA I-II patients over the age of 65 years were enrolled. The patients were randomly (by lot) assigned to receive one of the three doses of remifentanil infusion (0...
October 17, 2016: Current Medical Research and Opinion
David Ae Imber, Massimiliano Pirrone, Changsheng Zhang, Daniel F Fisher, Robert M Kacmarek, Lorenzo Berra
With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique...
September 13, 2016: Respiratory Care
Tanner McGinn, Morad Chughtai, Anil Bhave, Osman Ali, Prathik Mudaliar, Anton Khlopas, Steven F Harwin, Michael A Mont
INTRODUCTION: Patients may experience knee stiffness following total knee arthroplasty (TKA). Non-operative measures, such as more physical therapy and special splints are warranted in such cases. In the event of failure of these measures to restore knee range of motion, more invasive procedures with higher risks, such as manipulation under anesthesia (MUA) or repeat surgery, can be utilized. Thus, it becomes essential to optimize their non-operative measures in order to avoid more invasive, riskier options...
September 10, 2016: Surgical Technology International
Emanuela Viviani, Anna Maria Giribono, Donatella Narese, Doriana Ferrara, Giuseppe Servillo, Luca Del Guercio, Umberto Marcello Bracale
Compartment syndrome (CS) is a pathological increase of the interstitial pressure within the closed osseous fascial compartments. Trauma is the most common cause, followed by embolization, burns, and iatrogenic injuries; it usually involves the limbs. The major issue when dealing with CS is the possibility to do an early diagnosis in order to intervene precociously, through a fasciotomy, reducing the risk of tissue, vascular and nervous damage. Although it is an infrequent condition, it is potentially life threatening...
August 31, 2016: International Journal of Lower Extremity Wounds
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
Samir M Kendale, Jeanna D Blitz
STUDY OBJECTIVE: Obese patients regularly present for surgery and have greater hypoxemia risk. This study aimed to identify the risk and incidence of intraoperative hypoxemia with increasing body mass index (BMI). DESIGN: This was a retrospective cohort study. SETTING: Operating room. PATIENTS: A total of 15,238 adult patients who underwent general anesthesia for elective noncardiac surgery at a single large urban academic institution between January 2013 and December 2014...
September 2016: Journal of Clinical Anesthesia
Katherine Davidson, Robert J Schroth, Jeremy A Levi, Aaron B Yaffe, Betty-Anne Mittermuller, Elizabeth A C Sellers
BACKGROUND: Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay in preschool children affecting quality of life and nutritional status. The purpose was to determine whether there is an association between Body Mass Index (BMI) and S-ECC. METHODS: Children with S-ECC were recruited on the day of their slated dental surgery under general anesthesia. Age-matched, caries-free controls were recruited from the community. All children were participating in a larger study on nutrition and S-ECC...
2016: BMC Pediatrics
Shaun Patel, Krystal L Weierstahl, Sonalee Shah, Christina W Fidkowski
The maternal mortality rate for parturients with severe pulmonary hypertension is 30% to 50%. General, epidural, and combined low-dose spinal-epidural anesthesia have been used successfully for cesarean deliveries in patients with pulmonary hypertension. We describe a cesarean delivery performed using an intrathecal catheter in a 25-year-old morbidly obese (body mass index, 82 kg/m) woman (gravida 3, para 2 at 32 weeks of gestation) who had severe pulmonary hypertension, right ventricular failure, pulmonary emboli, and obstructive sleep apnea...
October 1, 2016: A & A Case Reports
Agnieszka Baranowska, Beata Skowron, Katarzyna Ciesielczyk, Justyna Domagała, Piotr J Thor
INTRODUCTION: High-calorie diet is responsible for excessive weight gain. Obesity has recently become world epidemics, affecting not only adults but also children, which makes it the biggest health problem in the world. Yet the underlying mechanism remains a matter of debate. OBJECTIVES: The aim of this study is to clarify the role of gender in high fat diet induced obesity in pups and adult animals. MATERIALS AND METHODS: Female rats were fed low/ high fat diet during mating, pregnancy and lactation...
2016: Folia Medica Cracoviensia
Sanna Halonen, Kari Annala, Juho Kari, Samuli Jokinen, Aki Lumme, Kai Kronström, Arvi Yli-Hankala
Lumbar puncture is a relatively safe procedure, but some serious, even fatal, complications can occur. Needle guidance can increase puncture accuracy, decrease the number of attempts, and make the procedure easier. We tested the feasibility of a bioimpedance-based tissue-sensing technology for needle guidance in clinical use. The Bioimpedance Probe (BIP) Needle has a removable BIP stylet enabling measurement of bioimpedance spectra during the procedure. The BIP Needle is connected to a measurement device that uses tissue-classification software, and the device provides audiovisual feedback when it detects cerebrospinal fluid (CSF)...
August 4, 2016: Journal of Clinical Monitoring and Computing
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