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Obesity anaesthesia

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https://www.readbyqxmd.com/read/27869287/dexmedetomidine-for-attenuating-haemodynamic-response-to-intubation-stimuli-in-morbidly-obese-patients-anaesthetised-using-low-opioid-technique-comparison-with-fentanyl-based-general-anaesthesia
#1
Tomasz Gaszyński, Klaudia Czarnik, Łukasz Łaziński, Wojciech Gaszyński
BACKGROUND: Anaesthesiologists are facing the problem of an increasing population of morbidly obese patients. In order to minimize the risk of opioid-induced postoperative respiratory failure, the intraoperative administration of opioids should be reduced or replaced with other drugs. The purpose of this study was to compare haemodynamic response elicited by intubation in morbidly obese patients between two variants of anaesthesia induction: fentanyl-based or low-opioid using dexmedetomidine...
November 21, 2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27867510/effect-of-adding-intrathecal-morphine-to-a-multimodal-analgesic-regimen-for-postoperative-pain-management-after-laparoscopic-bariatric-surgery-a-prospective-double-blind-randomized-controlled-trial
#2
Fatma Adel El Sherif, Ahmed Hassan Othman, Ahmad Mohammad Abd El-Rahman, Osama Taha
BACKGROUND: Pain control after bariatric surgery is a major challenge. Our objective was to study the efficacy and safety of intrathecal (IT) morphine 0.3 mg added to bupivacaine 0.5% for postoperative pain after laparoscopic bariatric surgery. METHODS: After local ethics committee approval, 100 morbidly obese patients scheduled for laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned into two groups: Group I received IT 0...
November 2016: British Journal of Pain
https://www.readbyqxmd.com/read/27844477/videolaryngoscopy-versus-direct-laryngoscopy-for-adult-patients-requiring-tracheal-intubation
#3
REVIEW
Sharon R Lewis, Andrew R Butler, Joshua Parker, Tim M Cook, Andrew F Smith
BACKGROUND: Successful tracheal intubation during general anaesthesia traditionally requires a line of sight to the larynx attained by positioning the head and neck and using a laryngoscope to retract the tongue and soft tissues of the floor of the mouth. Difficulties with intubation commonly arise, and alternative laryngoscopes that use digital and/or fibreoptic technology have been designed to improve visibility when airway difficulty is predicted or encountered. Among these devices, a rigid videolaryngoscope (VLS) uses a blade to retract the soft tissues and transmits a lighted video image to a screen...
November 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27797096/a-comparison-of-bis-recordings-during-propofol-based-total-intravenous-anaesthesia-and-sevoflurane-based-inhalational-anaesthesia-in-obese-patients
#4
Tomasz Gaszyński, Andrzej Wieczorek
BACKGROUND: Intraoperative awareness is a rarely occurring phenomenon. Obesity is considered as one of the factors increasing the probability of intraoperative awareness due to problems with the dosing of anaesthetics. In a randomized prospective study we compared bispectral index (BIS) recordings during propofol-based total intravenous anaesthesia (TIVA) and sevoflurane-based inhalation anaesthesia in morbidly obese patients as a sign of possible intraoperative awareness. METHODS: 120 morbidly obese patients were randomly allocated into two subgroups: TIVA or SEVO...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/27770778/observational-study-on-patterns-of-neuromuscular-blockade-reversal
#5
Timur Dubovoy, Michelle Housey, Scott Devine, Sachin Kheterpal
BACKGROUND: Using electronic health record data, we hypothesized that larger reversal doses are used for patients with deeper levels of neuromuscular blockade (NMB) as evidenced by the last recorded TOF measurement. We also examined if dosing regimens reflect current practice guidelines of using ideal body weight (IBW) for NMB agents and total body weight (TBW) for neostigmine. METHODS: This is a retrospective observational study of adult, ASA 1-4 patients who underwent general anaesthesia and received non-depolarizing NMB agents between 01/01/2004 and 12/31/2013...
October 22, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27638980/the-impact-of-maternal-obesity-on-breastfeeding
#6
Naila Ramji, James Quinlan, Phil Murphy, Joan M G Crane
OBJECTIVE: To compare the rate of any breastfeeding at the time of postpartum hospital discharge between obese women (BMI ≥ 30.00 kg/m(2)) and women with a normal BMI (18.50 to 24.99 kg/m(2)). METHODS: We conducted a retrospective cohort study of women with live, singleton pregnancies who delivered in St. John's, Newfoundland and Labrador between 2002 and 2011, using data from the Newfoundland and Labrador provincial perinatal registry. The primary outcome was any breastfeeding at the time of discharge from hospital...
August 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/27608347/anaesthetists-experiences-with-the-early-labour-epidural-recommendation-for-obese-parturients-a-qualitative-study
#7
V A Eley, L K Callaway, A A J van Zundert, J Lipman, C Gallois
Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. This qualitative study explored the experiences of anaesthetists regarding early epidural analgesia in obese parturients, to answer the research question: Are anaesthetists consistent in how they apply early epidural analgesia in obese parturients? Personal in-depth interviews with 42 specialist anaesthetists working in south-east Queensland, Australia, were completed between February and April, 2015...
September 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27608337/anaesthetic-management-of-obese-parturients-what-is-the-evidence-supporting-practice-guidelines
#8
V A Eley, A A J van Zundert, J Lipman, L K Callaway
Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) ≥ 40 kg/m(2) and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care...
September 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27492516/perioperative-respiratory-care-in-obese-patients-undergoing-bariatric-surgery-implications-for-clinical-practice
#9
REVIEW
Sjaak Pouwels, Frank W J M Smeenk, Loes Manschot, Bianca Lascaris, Simon Nienhuijs, R Arthur Bouwman, Marc P Buise
Obesity is an increasing problem worldwide. The number of people with obesity doubled since the 1980's to affect an estimated 671 million people worldwide. Obese patients in general have an altered respiratory physiology and can have an impaired lung function, which leads to an increased risk of developing pulmonary complications during anaesthesia and after bariatric surgery (approximately 8%). Therefore the respiratory management of the bariatric surgical patient provides a number of challenges. This review will focus on the perioperative respiratory care in bariatric surgical patients discussing respiratory physiology in the obese and perioperative respiratory care in bariatric surgery...
August 2016: Respiratory Medicine
https://www.readbyqxmd.com/read/27418005/multimodal-analgesia-model-to-achieve-low-postoperative-opioid-requirement-following-bariatric-surgery
#10
K Ky Lam, W Lm Mui
OBJECTIVE: To investigate whether a new anaesthesia protocol can reduce opioid use in obese patients following laparoscopic sleeve gastrectomy. METHODS: This prospective observational case series was conducted in a private hospital in Hong Kong that has been accredited as a Centre of Excellence for Bariatric Surgery. Thirty consecutive patients scheduled for laparoscopic sleeve gastrectomy from 1 January 2015 to 31 March 2015 were reviewed. RESULTS: Of the 30 patients, 14 (46...
October 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/27377635/sleeve-gastrectomy-versus-roux-en-y-gastric-bypass-for-type-2-diabetes-and-morbid-obesity-double-blind-randomised-clinical-trial-protocol
#11
Rinki Murphy, Nicholas J Evennett, Michael G Clarke, Steven J Robinson, Lee Humphreys, Bronwen Jones, David D Kim, Richard Cutfield, Lindsay D Plank, Hisham Hammodat, Michael W C Booth
INTRODUCTION: Type 2 diabetes (T2D) in association with obesity is an increasing disease burden. Bariatric surgery is the only effective therapy for achieving remission of T2D among those with morbid obesity. It is unclear which of the two most commonly performed types of bariatric surgery, laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), is most effective for obese patients with T2D. The primary objective of this study is to determine whether LSG or LRYGB is more effective in achieving HbA1c<6% (<42 mmol/mol) without the use of diabetes medication at 5 years...
2016: BMJ Open
https://www.readbyqxmd.com/read/27366507/turkish-anaesthesiologist-s-experiences-of-anaesthetic-management-of-patients-with-obstructive-sleep-apnea-osa
#12
Mesut Erbaş, Hasan Ali Kiraz, Tuncer Şimşek, Hasan Şahin, Hüseyin Toman, Volkan Hancı
OBJECTIVE: Obstructive sleep apnea (OSA) is an important health problem that is increasing with the increase in the incidence of obesity. For patients with OSA, it is reported that preoperative OSA diagnosis is made in only 10%-20% of the patients. Therefore, it gains importance that these patients are diagnosed in the preoperative period. The aim of this study is to analyze with a survey the experiences of anaesthesia experts working in Turkey about the diagnosis of patients with OSA, anaesthetic methods and postoperative care...
August 2015: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/27218200/pneumothorax-following-shoulder-arthroscopy-under-combined-regional-and-general-anaesthesia-a-case-report
#13
Oskar Leander-Olsson, Anna Borglund-Hemph, Jan G Jakobsson
INTRODUCTION: Pneumothorax is a most rare intraoperative event but jeopardise safety. Risk factors for its occurrence should be acknowledged and it should be considered in cases of unexpected deterioration of oxygenation that not respond to standard management to improve oxygenation. PRESENTATION OF CASE: We describe a patient with mild obesity and recent shoulder trauma scheduled for elective arthroscopy under combined interscalene block and general anaesthesia in the beach chair position...
2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27217334/the-surgical-approach-to-near-total-small-bowel-infarction-in-a-patient-with-massive-portomesenteric-thrombosis-case-report
#14
Savino Occhionorelli, Alessandra La Manna, Rocco Stano, Lucia Morganti, Giorgio Vasquez
AIM: To describe an acute portomesenteric venous thrombosis, with massive small bowel infarction, which is managed with small bowel resection, primary anastomosis, and open abdomen management (OAM). CASE REPORT: A 76-year-old male patient was admitted to the surgical ward, complaining spread abdominal pain. Contrast Enhanced Computed Tomography (CECT) diagnosed massive bowel ischemia, caused by portomesenteric thrombosis. He had negative coagulation tests for thrombophilia, while he presented concomitant risk factors (cancer, previous venous thrombosis, obesity)...
May 23, 2016: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/27190922/optimal-dose-of-intrathecal-dexmedetomidine-in-lower-abdominal-surgeries-in-average-indian-adult
#15
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
https://www.readbyqxmd.com/read/27067606/successful-percutaneous-management-of-symptomatic-central-posterior-epidural-baastrup-cyst-a-potential-surgical-sparing-option
#16
Jordan Breed, Tony Goldschlager, Ronil V Chandra
BACKGROUND CONTEXT: Neurogenic claudication from posterior epidural extension of a Baastrup interspinous bursal cyst is rare. Surgical decompression is the gold standard of treatment. This case report describes successful percutaneous treatment with good early clinicoradiological outcome. PURPOSE: This study aimed to describe the successful percutaneous treatment of a central posterior epidural Baastrup cyst causing neurogenic claudication. STUDY DESIGN: This is a case report study...
September 2016: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/27037981/a-randomised-cross-over-comparison-of-the-transverse-and-longitudinal-techniques-for-ultrasound-guided-identification-of-the-cricothyroid-membrane-in-morbidly-obese-subjects
#17
M S Kristensen, W H Teoh, S S Rudolph, R Hesselfeldt, J Børglum, M F Tvede
We compared the transverse and longitudinal approaches to ultrasound-guided identification of the cricothyroid membrane, to determine which was faster and more successful. Forty-two anaesthetists received a one-hour structured training programme consisting of e-learning, a lecture and hands-on training, and then applied both techniques in a randomised, cross-over sequence to obese females with body mass index 39.0 - 43.9 kg.m(-2) . The mean (SD) time to identify the cricothyroid membrane was 24.0 (12.4) s using the transverse technique compared with 37...
June 2016: Anaesthesia
https://www.readbyqxmd.com/read/26966106/etomidate-but-not-thiopental-decreases-serum-cortisol-concentration-in-morbidly-obese-patients-a-randomized-controlled-trial
#18
Marcin Możański, Dariusz Tomaszewski, Zbigniew Rybicki, Jolanta Bejm, Mariusz Bałkota
BACKGROUND: The effect of etomidate administration on the adrenal cortex in obese patients is still unclear. The objective of the study was to determine the influence of a single dose of etomidate on cortisol secretion in the morbidly obese. METHODS: 127 healthy patients were enrolled into the study. Data from 82 patients scheduled for elective laparoscopic surgery were analyzed. 62 of them were morbidly obese, while 20 had normal body mass. The participants were divided equally into etomidate and thiopental groups, depending on the kind of intravenous anaesthetic used for the induction of anaesthesia...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26936068/-chronic-locked-posterior-shoulder-dislocation-treated-by-anatomical-total-shoulder-arthroplasty
#19
V Popelka
The aim of this study was to present the results of surgical treatment in two male patients with chronic locked posterior dislocation of the shoulder, who underwent total shoulder arthroplasty due to destruction of more than 45% of the humeral head articular surface and glenoid impairment. The deltopectoral approach was used in both cases. Total shoulder arthroplasty (Epoca-Synthes) was carried out in the standard manner. Case one: A 29-year-old, extremely obese patient suffered injury to his shoulder during an epileptic seizure...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/26917599/current-practice-of-rapid-sequence-induction-of-anaesthesia-in-the-uk-a-national-survey
#20
A Sajayan, J Wicker, N Ungureanu, C Mendonca, P K Kimani
BACKGROUND: The 'classical' technique of rapid sequence induction (RSI) of anaesthesia was described in 1970. With the introduction of new drugs and equipment in recent years, a wide variation in this technique has been used. The role of cricoid pressure is controversial because of the lack of scientific evidence. Moreover, gentle mask ventilation has been recommended in situations such as obesity and critically ill patients, to prevent hypoxaemia during the apnoeic period. In identifying multiple techniques, we conducted a national postal survey to establish the current practice of RSI in the UK...
September 2016: British Journal of Anaesthesia
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