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anesthesia and morbid obesity

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https://www.readbyqxmd.com/read/29050063/-update-in-obstetric-anesthesia-tried-and-trusted-methods-controversies-and-new-perspectives-part-1
#1
Peter Kranke, Thorsten Annecke, Dorothee H Bremerich, Daniel Chappell, Thierry Girard, Wiebke Gogarten, Robert Hanß, Lutz Kaufner, Sophie Neuhaus, Tobias Ninke, Thomas Standl, Stefan Weber, Yvonne Jelting, Thomas Volk
Since 1975, a plethora of lectures within the context of annual meetings relevant for the clinical care has been summarized in "what's new in obstetric anesthesia" by the Society for Obstetric Anesthesia and Perinatology which can be recommended to everyone interested in anaesthesiology in the delivery room. After the death of Gerard W. Ostheimer, Professor of Anaesthesiology at Brigham and Women's Hospital in Boston, Massachusetts, it became renamed the Gerard W. Ostheimer "what's new in obstetric anesthesia" lecture to honor his contributions to regional anesthesia and obstetric anaesthesia...
October 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29049219/risk-assessment-of-morbidly-obese-parturient-in-cesarean-section-delivery-a-prospective-cohort-single-center-study
#2
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/28965158/influence-of-non-invasive-blood-pressure-measurement-intervals-on-the-occurrence-of-intra-operative-hypotension
#3
Grant H Kruger, Amy Shanks, Sachin Kheterpal, Tyler Tremper, Chi-Jung Chiang, Robert E Freundlich, James M Blum, Albert J Shih, Kevin K Tremper
The American Society of Anesthesiologists Standards for Basic Monitoring recommends blood pressure (BP) measurement every 5 min. Research has shown distractions or technical factors can cause prolonged measurement intervals exceeding 5 min. We investigated the relationship between prolonged non-invasive BP (NIBP) measurement interval and the incidence of hypotension, detected post-interval. Our secondary outcome was to determine independent predictors of these prolonged NIBP measurement intervals. Retrospective data were analyzed from 139,509 general anesthesia cases from our institution's Anesthesia Information Management System (AIMS)...
September 30, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28928583/single-minute-of-positive-end-expiratory-pressure-at-the-time-of-induction-effect-on-arterial-blood-gases-and-hemodynamics-in-morbidly-obese-patients-undergoing-laparoscopic-bariatric-surgery
#4
Dipti Saxena, Priyank Singh, Atul Dixit, Bipin Arya, Mohit Bhandari, Sadhana Sanwatsarkar
BACKGROUND: The effect of positive end-expiratory pressure (PEEP) has been studied in detail after induction of general anesthesia especially in obese individuals. However, sparse information can be gathered from the literature regarding its effect when applied at the time of induction and the time of onset of its effect. Thus, this study was planned to assess the effect of PEEP when applied for a single minute in morbidly obese patients. MATERIALS AND METHODS: This was a randomized prospective study comprising seven morbidly obese patients (body mass index ≥40 kg/m(2))...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28916989/comparison-of-the-recovery-profile-between-desflurane-and-sevoflurane-in-patients-undergoing-bariatric-surgery-a-meta-analysis-of-randomized-controlled-trials
#5
REVIEW
Preet Mohinder Singh, Anuradha Borle, Jason McGavin, Anjan Trikha, Ashish Sinha
Early and clear recovery from anesthesia is the crux for preventing perioperative complications in the obese undergoing bariatric surgery. Volatile inhalation agents by virtue of high lipid solubility are expected to produce residual anesthetic effects. Prospective randomized trials comparing desflurane and sevoflurane used for anesthesia maintenance (electroencephalograph guided) during bariatric surgery published till 1st of July 2017 were searched in the medical database. Comparisons were made for surrogate markers of recovery from anesthesia that included time to eye-opening (TEo), time to tracheal-extubation (TEx), and Aldrete scores on immediately shifting to recovery (Ald-I)...
September 16, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28875259/the-impact-of-obesity-on-30-day-complications-in-pediatric-surgery
#6
A T Train, S B Cairo, H A Meyers, C M Harmon, D H Rothstein
PURPOSE: To examine the effects of obesity on specialty-specific surgical outcomes in children. MATERIALS AND METHODS: Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis...
September 5, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28861414/continuous-spinal-anesthesia-for-obstetric-anesthesia-and-analgesia
#7
REVIEW
Ivan Veličković, Borislava Pujic, Charles W Baysinger, Curtis L Baysinger
The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28857813/risk-factors-and-mitigation-strategies-for-pancreatic-fistula-after-distal-pancreatectomy-analysis-of-2026-resections-from-the-international-multi-institutional-distal-pancreatectomy-study-group
#8
Brett L Ecker, Matthew T McMillan, Valentina Allegrini, Claudio Bassi, Joal D Beane, Ross M Beckman, Stephen W Behrman, Euan J Dickson, Mark P Callery, John D Christein, Jeffrey A Drebin, Robert H Hollis, Michael G House, Nigel B Jamieson, Ammar A Javed, Tara S Kent, Michael D Kluger, Stacy J Kowalsky, Laura Maggino, Giuseppe Malleo, Vicente Valero, Lavanniya K P Velu, Amarra A Watkins, Christopher L Wolfgang, Amer H Zureikat, Charles M Vollmer
OBJECTIVE: To identify a clinical fistula risk score following distal pancreatectomy. BACKGROUND: Clinically relevant pancreatic fistula (CR-POPF) following distal pancreatectomy (DP) is a dominant contributor to procedural morbidity, yet risk factors attributable to CR-POPF and effective practices to reduce its occurrence remain elusive. METHODS: This multinational, retrospective study of 2026 DPs involved 52 surgeons at 10 institutions (2001-2016)...
August 29, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28828532/pharmacokinetic-and-pharmacodynamics-of-intravenous-dexmedetomidine-in-morbidly-obese-patients-undergoing-laparoscopic-surgery
#9
Bo Xu, Dongxu Zhou, Li Ren, Steven Shulman, Xingan Zhang, Ming Xiong
BACKGROUND: This study was designed to investigate the pharmacokinetics and pharmacodynamics of dexmedetomidine in morbidly obese patients undergoing laparoscopic surgery. METHODS: Morbidly obese (body mass index ≥40 kg/m(2)) and normal weight patients scheduled for elective laparoscopic surgery were included (n = 8, each group). After baseline hemodynamic measurement, dexmedetomidine 1 μg/kg was administered over 10 min. General anesthesia was induced with propofol 1...
August 21, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28762023/efficacy-of-goal-directed-fluid-therapy-via-pleth-variability-index-during-laparoscopic-roux-en-y-gastric-bypass-surgery-in-morbidly-obese-patients
#10
İsmail Demirel, Esef Bolat, Aysun Yıldız Altun, Mustafa Özdemir, Azize Beştaş
BACKGROUND: There is no well-recognized guideline for intraoperative fluid management in bariatric surgery. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management which was shown to improve patients' prognoses. Dynamic indicators may better predict fluid response compared to static indicators. In this study, we aimed to assess effects of administering GDFT protocol via Pleth Variability Index (PVI) in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) surgery...
July 31, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28717532/retrograde-intrarenal-surgery-for-renal-stones-part-1
#11
REVIEW
Ben Van Cleynenbreugel, Özcan Kılıç, Murat Akand
The main aim in the treatment of renal stones is to clearance of the stones completely with the least morbidity. Parallel to the improvements in technology during recent years, new flexible ureterorenoscopes and effective lithotripters such as holmium laser have been developed, thus retrograde intrarenal surgery (RIRS) has become an efficient and safe option in the management of urinary system stone disease with a gradually increasing popularity. Therewithal, innovations in auxiliary equipment such as guide-wires, ureteral access sheath and stone baskets have made this procedure more effective...
June 2017: Turkish Journal of Urology
https://www.readbyqxmd.com/read/28714298/effect-of-sugammadex-on-coagulation-as-detected-by-rotational-thromboelastometry-in-morbidly-obese-patients
#12
Michele Carron, Diana Bertini, Tancredi Prandini, Francesca Fanton, Mirto Foletto, Carlo Ori, Egle Perissinotto, Paolo Simioni
BACKGROUND: Sugammadex, which is used to reverse rocuronium-induced neuromuscular blockade, has a limited and transient effect on activated partial thromboplastin time and prothrombin time. However, no data are available on the effects of sugammadex on coagulation in morbidly obese patients, as assessed by rotational thromboelastometry (ROTEM®). METHODS: Sixty patients received sugammadex 2 mg/kg or 4 mg/kg to reverse moderate or deep rocuronium-induced neuromuscular blockade (n = 30/group) at the end of surgery under desflurane anesthesia...
July 13, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28542048/case-report-of-a-massive-retropharyngeal-goiter-resulting-in-laryngeal-compression
#13
Carissa M Thomas, Jameson K Mattingly, Adrian Hendrickse, John I Song
This is a rare presentation of a morbidly obese male with a massive retropharyngeal goiter causing laryngeal compressive symptoms and unique airway management challenges. Flexible laryngoscopy revealed a retropharyngeal mass circumferentially compressing the oropharynx and supraglottis and preventing the visualization of the glottis. Awake tracheostomy was performed before total thyroidectomy. Airway compression from a goiter typically results from substernal extension, which usually does not cause difficulty with endotracheal intubation...
September 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28541856/early-and-late-complications-in-laparoscopic-gastric-bypass-comparative-study-between-manual-and-stapled-anastomosis
#14
COMPARATIVE STUDY
Débora Acín-Gándara, Fernando Pereira-Pérez, Manuel Medina-García, Gil Rodriguez-Caravaca, Beatriz Martínez-Torres, Alfonso Antequera-Pérez, Alejandro Nájar García-Muñoz
The aim of this study is to evaluate the early and late complications of laparoscopic gastric bypass (GBP) with manual versus stapled gastrojejunal anastomosis. Eighty-two patients with morbid obesity and body mass index (35-56 kg/m2) who underwent GBP were divided into two groups: manual gastrojejunal anastomosis (Group 1) and stapled anastomosis (Group 2). Early and late complications were evaluated. No differences were found between both groups in age, sex, body mass index, American Society of Anesthesia classification, and comorbidity...
May 1, 2017: American Surgeon
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/28454590/protective-intraoperative-ventilation-with-higher-versus-lower-levels-of-positive-end-expiratory-pressure-in-obese-patients-probese-study-protocol-for-a-randomized-controlled-trial
#16
T Bluth, R Teichmann, T Kiss, I Bobek, J Canet, G Cinnella, L De Baerdemaeker, C Gregoretti, G Hedenstierna, S N Hemmes, M Hiesmayr, M W Hollmann, S Jaber, J G Laffey, M J Licker, K Markstaller, I Matot, G Müller, G H Mills, J P Mulier, C Putensen, R Rossaint, J Schmitt, M Senturk, A Serpa Neto, P Severgnini, J Sprung, M F Vidal Melo, H Wrigge, M J Schultz, P Pelosi, M Gama de Abreu
BACKGROUND: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients...
April 28, 2017: Trials
https://www.readbyqxmd.com/read/28319546/gastric-fluid-volume-change-after-oral-rehydration-solution-intake-in-morbidly-obese-and-normal-controls-a-magnetic-resonance-imaging-based-analysis
#17
Toshie Shiraishi, Dai Kurosaki, Mitsuyo Nakamura, Taiji Yazaki, Satomi Kobinata, Yosuke Seki, Kazunori Kasama, Hideki Taniguchi
BACKGROUND: Although preoperative fluid intake 2 hours before anesthesia is generally considered safe, there are concerns about delayed gastric emptying in obese subjects. In this study, the gastric fluid volume (GFV) change in morbidly obese subjects was investigated after ingesting an oral rehydration solution (ORS) and then compared with that in nonobese subjects. METHODS: GFV change over time after the ingestion of 500 mL of ORS containing 2.5% carbohydrate (OS-1) was measured in 10 morbidly obese subjects (body mass index [BMI], >35) scheduled for bariatric surgery and 10 nonobese (BMI, 19-24) using magnetic resonance imaging...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28243855/optimal-propofol-induction-dose-in-morbidly-obese-patients-a-randomized-controlled-trial-comparing-the-bispectral-index-and-lean-body-weight-scalar
#18
RANDOMIZED CONTROLLED TRIAL
Yamini Subramani, Waleed Riad, Frances Chung, Jean Wong
PURPOSE: Propofol dosing based on total body weight (TBW) can lead to overdosing in morbidly obese (MO) patients. Our aim was to determine whether an induction dose of propofol based on a bispectral index (BIS) target is better for achieving loss of consciousness in MO patients than dosing based on lean body weight (LBW). METHODS: Sixty MO patients with a body mass index (BMI) of ≥ 40 kg·m(-2) were randomized to either BIS- or LBW-based propofol dosing groups...
May 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28243748/pilot-study-comparing-post-anesthesia-care-unit-length-of-stay-in-moderately-and-severely-obese-children
#19
Hina Walia, Onur Balaban, Megan Jacklen, Dmitry Tumin, Vidya Raman, Joseph D Tobias
OBJECTIVE: Obesity is a risk factor for surgical complications in adults and children. Differences in postsurgical outcomes according to severity of obesity [moderate: 95-98th age-gender-specific body mass index (BMI) percentile versus severe: ≥99th percentile] in children remain unclear. This study compared post-anesthesia care unit (PACU) stay and hospital admission between severely obese children and moderately obese children undergoing surgery. METHODS: In a retrospective review over a 6-month period, obese children, 2-18 years of age undergoing surgery were identified...
August 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28183582/use-of-ultrasound-for-spinal-anesthesia-in-a-super-morbidly-obese-patient
#20
Yasuhiro Morimoto, Yoichiro Ihara, Yoko Shimamoto, Hiroko Shiramoto
We report the application of ultrasound prescans for spinal anesthesia to morbid obesity patient. A 38-year-old woman with a body mass index (BMI) of 50 (weight: 110 kg; height: 148 cm) was scheduled to undergo pilonidal cyst resection at the bottom of the tailbone. Spinal anesthesia was selected for the procedure, because the patient's position during the surgery was prone and the patient had morbid obesity. To determine the spinal needle insertion point and the distance between the skin and dura, we planned to use ultrasound...
February 2017: Journal of Clinical Anesthesia
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