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Obese anesthesia & 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
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
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
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
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
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
Ahmed Y Abdelbadee, Raj M Paspulati, Heather D McFarland, Mohamed A Bedaiwy, Leslie Ciancibello, Gina Anderson, Kristine M Zanotti
STUDY OBJECTIVES: To identify morphometric characteristics of obese patients that best predict pulmonary intolerance to robotic pelvic surgery using a novel method for quantifying adipose distribution. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Fifty-nine patients with endometrial cancer who underwent robotic hysterectomy and lymphadenectomy between April 2008 and May 2014 and also underwent perioperative computed tomography (CT) imaging within 1 year...
July 20, 2016: Journal of Minimally Invasive Gynecology
Mika Seto, Michitaka Matsuda, Kyoichi Narihira, Toshihiro Kikuta
We report a case of a morbidly obese man with an aortic aneurysm, in whom dental surgery was performed before elective cardiac surgery. His aortic aneurysm required emergency surgery. However, because of his morbid obesity, elective cardiac surgery was planned. Considering the high risk of infective endocarditis, dental surgery was required. Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position. Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations...
June 2016: Journal of the Korean Association of Oral and Maxillofacial Surgeons
Laura Mattheis, Juliane-Susanne Jung, Bernhard Hiebl, Wiebke Garrels, Heike Kielstein, Julia Spielmann
The incidence of obesity is on the rise in most western countries and represents major risks to health. Obesity causes complex metabolic dysfunctions and can be associated with a large number of secondary diseases. To investigate causal mechanisms of obesity and develop better options for treatment, researchers study the condition in animal models. In addition to genetically engineered animal models, diet-induced obesity is often used because it occurs similarly in animals as it does in humans. For several types of investigations that use obesity models, investigators must carry out surgical interventions and they frequently encounter severe perioperative complications induced by anesthesia...
June 21, 2016: Lab Animal
Willie H Scharwächter, Sander W M Keet, Katrin Stoecklein, Stephan A Loer, Christa Boer
STUDY OBJECTIVE: We investigated the prevalence of lifestyle risk factors in patients admitted to our preoperative assessment outpatient clinic, and compared patient self-reports and anesthetist reports of health risk factors to evaluate the patient self-image of preoperative health status. DESIGN: Cross-sectional survey. SETTING: The study was performed in an academic teaching hospital in Amsterdam, the Netherlands, during 3 consecutive months at the preoperative screening clinic...
August 2016: Journal of Clinical Anesthesia
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
Xavier Deffieux, Bertrand de Rochambeau, Gautier Chene, Tristan Gauthier, Samantha Huet, Géry Lamblin, Aubert Agostini, Maxime Marcelli, François Golfier
OBJECTIVE: The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease. METHODS: Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines). RESULTS: Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (gradeC)...
July 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Shagufta Naaz, Jahanara Bandey, Erum Ozair, Adil Asghar
BACKGROUND: Dexmedetomidine, a selective alpha2 adrenoceptor agonist, has been used as adjuvant to spinal anaesthesia. AIM: To find out the optimum dose of dexmedetomidine to be used in lower abdomen surgery intrathecally. MATERIALS AND METHODS: This was a randomized, controlled, double blinded study which included adult ASA I and II patients. They were allocated into five groups (n=20). Patients allergic to drugs to be used in the study and those with co-existing neurological disorders, coagulopathies, cardiac diseases, obesity and hypertension were excluded...
April 2016: Journal of Clinical and Diagnostic Research: JCDR
Shunsuke Saima, Takashi Asai, Yasuhisa Okuda
An obese patient was scheduled for shoulder joint surgery under general anesthesia. After induction of anesthesia and tracheal intubation, insertion of a gastric tube was difficult. A new tracheal tube was prepared, the connecter was removed, and the tube was cut longitudinally. The tube was inserted orally into the esophagus. A gastric tube was passed through the nose, and its tip was taken out of the mouth. The tip of the gastric tube was passed through the tracheal tube, and its correct position in the stomach was confirmed by auscultation of the epigastrium...
April 2016: Masui. the Japanese Journal of Anesthesiology
Maddalena Zampi, Carmine Iacovazzo, Tommaso Pagano, Pasquale Buonanno, Mariella Carlomagno, Flavia Cianciulli, Giuseppe Servillo
Pain management is extremely important in day surgery, and it is one of the limiting factors for this type of procedures. Locoregional anesthesia is strongly recommended for day surgery; nevertheless, it could be very difficult to localize nerve position especially in obese patients. Furthermore, a complete nerve blockade could result in a delayed discharge. We present a case of analgesic ultrasound-guided block of tibial and common peroneal nerves in the popliteal fossa without any motor function involvement in an obese patient undergoing debridement of an infected lower limb ulcer; all previous attempts of surgical debridement in day surgery with topical anesthetics had failed because of discomfort due to pain...
June 2016: International Journal of Lower Extremity Wounds
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