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Chen H, Wang X, Zhang Y, Liu W, Zhou C, Zheng D. Effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery. Perioper Med (Lond) 2024; 13:42. [PMID: 38755633 PMCID: PMC11100160 DOI: 10.1186/s13741-024-00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE This research aimed to ascertain the effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery. METHODS Obese patients undergoing laparoscopic surgery under general anesthesia were separated into the control group (group C) and the dexmedetomidine group (group D) (n = 30). Patients in group D were infused with dexmedetomidine (1 μg/kg) intravenously for 10 min and then at a rate of 0.5 mg/kg h until 30 min before the end of the surgery, and those in group C were infused with an equal volume of saline. The surgery time points were divided into: before anesthesia induction (T0), 5 min after intubation (T1), 30 min after pneumoperitoneum (T2), 10 min after pneumoperitoneum release (T3), at the time of extubation (T4), 3 min after extubation (T5), and 24 h after surgery (T6). Arterial blood was collected for blood gas analysis to record arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). Dynamic lung compliance (Cdyn), oxygenation index (OI), alveolar-arterial oxygen partial pressure difference (A-aDO2), and respiratory index (RI) were calculated. The time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation were recorded. Plasma IL-8 and IL-10 levels were measured from T0 to T6. RESULTS The time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation in group D were not statistically significant when compared with those in group C. Versus at the T1 time point, A-aDO2 and RI were higher and Cdyn and OI were lower in both groups at T2 and T3 time points. Versus group C, group D had higher Cdyn and OI and lower A-aDO2 and RI at T2 and T3 time points. Versus at the T0 time point, at each time point from T1 to T6, IL-8 and IL-10 levels were higher in both groups. Versus group C, group D had lower IL-8 and higher IL-10 levels at each time point from T1 to T6. CONCLUSION In obese patients undergoing laparoscopic surgery under general anesthesia, the use of dexmedetomidine can improve the lung compliance and OI of the patients, inhibit the inflammatory response of the lungs of the patients and thus have a certain protective effect on the lung function.
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Affiliation(s)
- Huan Chen
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Xin Wang
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Yawen Zhang
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Wei Liu
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Changhao Zhou
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Deli Zheng
- Department of Anesthesiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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Lian J, Wang Y, Yan X, Xu G, Jia M, Yang J, Ying J, Teng H. Development and validation of a nomogram to predict the risk of surgical site infection within 1 month after transforaminal lumbar interbody fusion. J Orthop Surg Res 2023; 18:105. [PMID: 36788621 PMCID: PMC9930234 DOI: 10.1186/s13018-023-03550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/19/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Surgical site infection (SSI), a common serious complication within 1 month after transforaminal lumbar interbody fusion (TLIF), usually leads to poor prognosis and even death. The objective of this study is to investigate the factors related to SSI within 1 month after TLIF. We have developed a dynamic nomogram to change treatment or prevent infection based on accurate predictions. MATERIALS AND METHODS We retrospectively analyzed 383 patients who received TLIF at our institution from January 1, 2019, to June 30, 2022. The outcome variable in the current study was the occurrence of SSI within 1 month after surgery. Univariate logistic regression analysis was first performed to assess risk factors for SSI within 1 month after surgery, followed by inclusion of significant variables at P < 0.05 in multivariate logistic regression analysis. The independent risk variables were subsequently utilized to build a nomogram model. The consistency index (C-index), calibration curve and receiver operating characteristic curve were used to evaluate the performance of the model. And the decision curve analysis (DCA) was used to analyze the clinical value of the nomogram. RESULTS The multivariate logistic regression models further screened for three independent influences on the occurrence of SSI after TLIF, including lumbar paraspinal (multifidus and erector spinae) muscles (LPM) fat infiltration, diabetes and surgery duration. Based on the three independent factors, a nomogram prediction model was built. The area under the curve for the nomogram including these predictors was 0.929 in both the training and validation samples. Both the training and validation samples had high levels of agreement on the calibration curves, and the nomograms C-index was 0.929 and 0.955, respectively. DCA showed that if the threshold probability was less than 0.74, it was beneficial to use this nomograph to predict the risk of SSI after TLIF. In addition, the nomogram was converted to a web-based calculator that provides a graphical representation of the probability of SSI occurring within 1 month after TLIF. CONCLUSION A nomogram including LPM fat infiltration, surgery duration and diabetes is a promising model for predicting the risk of SSI within 1 month after TLIF. This nomogram assists clinicians in stratifying patients, hence boosting decision-making based on evidence and personalizing the best appropriate treatment.
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Affiliation(s)
- Jiashu Lian
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Yu Wang
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Xin Yan
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Guoting Xu
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Mengxian Jia
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Jiali Yang
- grid.417384.d0000 0004 1764 2632Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027 Zhejiang China
| | - Jinwei Ying
- grid.414906.e0000 0004 1808 0918Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500 Zhejiang China
| | - Honglin Teng
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 32500, Zhejiang, China.
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Effects of individualized PEEP obtained by two different titration methods on postoperative atelectasis in obese patients: study protocol for a randomized controlled trial. Trials 2021; 22:704. [PMID: 34654446 PMCID: PMC8517565 DOI: 10.1186/s13063-021-05671-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of postoperative pulmonary complications (PPCs) is higher in obese patients undergoing general anesthesia and mechanical ventilation due to the reduction of oxygen reserve, functional residual capacity, and lung compliance. Individualized positive end-expiratory pressure (iPEEP) along with other lung-protective strategies is effective in alleviating postoperative atelectasis. Here, we compared the best static lung compliance (Cstat) titration of iPEEP with electrical impedance tomography (EIT) titration to observe their effects on postoperative atelectasis in obese patients undergoing laparoscopic surgery. Methods A total number of 140 obese patients with BMI ≥ 32.5kg/m2 undergoing elective laparoscopic gastric volume reduction and at moderate to high risk of developing PPCs will be enrolled and randomized into the optimal static lung compliance-directed iPEEP group and EIT titration iPEEP group. The primary endpoint will be pulmonary atelectasis measured and calculated by EIT immediately after extubation and 2 h after surgery. Secondary endpoints will be intraoperative oxygenation index, organ dysfunction, incidence of PPCs, hospital expenses, and length of hospital stay. Discussion Many iPEEP titration methods effective for normal weight patients may not be appropriate for obese patients. Although EIT-guided iPEEP titration is effective in obese patients, its high price and complexity limit its application in many clinical facilities. This trial will test the efficacy of iPEEP via the optimal static lung compliance-guided titration procedure by comparing it with EIT-guided PEEP titration. The results of this trial will provide a feasible and convenient method for anesthesiologists to set individualized PEEP for obese patients during laparoscopic surgery. Trial registration ClinicalTrials.govChiCTR2000039144. Registered on October 19, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05671-1.
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Adabala V, Tripathi M, Gupta P, Parameswaran P, Challa R, Kumar A. Effects of intraoperative inverse ratio ventilation on postoperative pulmonary function tests in the patients undergoing laparoscopic cholecystectomy: A prospective single blind study. Indian J Anaesth 2021; 65:S86-S91. [PMID: 34188261 PMCID: PMC8191195 DOI: 10.4103/ija.ija_1453_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/21/2020] [Accepted: 03/13/2021] [Indexed: 11/06/2022] Open
Abstract
Background and Aims: Induction of general anaesthesia is associated with development of atelectasis in the lungs, which may further lead to postoperative pulmonary complications. Inverse ratio ventilation (IRV) has shown to improve oxygenation and minimise further lung injury in patients with acute respiratory distress syndrome. We evaluated the safety and effectiveness of IRV on intraoperative respiratory mechanics and postoperative pulmonary function tests (PFTs). Methods: In a prospective, controlled study, 128 consecutive patients with normal preoperative PFTs who underwent elective laparoscopic cholecystectomy were randomised into IRV and conventional ventilation groups. Initially, all patients were ventilated with settings of tidal volume 8 mL/kg, respiratory rate 12/min, inspiratory/expiratory ratio (I: E) = 1:2, positive end expiratory pressure = 0. Once the pneumoperitoneum was created, the conventional group patients were continued to be ventilated with same settings. However, in the IRV group, I: E ratio was changed to 2:1. Peak pressure (Ppeak), Plateau pressure (Pplat) and lung compliance were measured. Haemodynamic parameters and arterial blood gas values were also measured. PFTs were repeated in postoperative period. Statistical tool included Chi-square test. Results: There was no significant difference in PFTs in patients who underwent IRV as compared to conventional ventilation [forced vital capacity (FVC) 2.52 ± 0.13 versus 2.63 ± 0.16, P = 0.28]. The Ppeak (cmH2O) and Pplat (cmH2O) were statistically lower in IRV patients [Ppeak 21.4 ± 3.4 versus 22.4 ± 4.2, P = 0.003] [Pplat 18.7 ± 2.4 versus 19.9.4 ± 3.2, P = 0.008]. There was no significant difference in lung compliance and oxygenation intraoperatively. Conclusion: Intraoperative IRV led to reduced airway pressures; however, it did not prevent deterioration of PFTs in postoperative period.
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Affiliation(s)
- Vijay Adabala
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Mukesh Tripathi
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Priyanka Gupta
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Prabakaran Parameswaran
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Revanth Challa
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
| | - Ajit Kumar
- Department of Anaesthesia, 6 level, Medical College Building, All India Institute of Medical Sciences (A.I.I.M.S.), Rishikesh, Uttarakhand, India
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Effects of Sevoflurane versus Propofol on Endogenous Nitric Oxide Metabolism during Laparoscopic Surgery. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6691943. [PMID: 33613928 PMCID: PMC7875642 DOI: 10.1155/2021/6691943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/26/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022]
Abstract
For laparoscopic surgery, it is very difficult to assess the effect of different medicines used in the surgical procedure on the surgical results. In the past, doctors could use sevoflurane to numb and calm patients. For decades, this type of treatment has been fairly reliable and effective, but for laparoscopic surgery, the use of sevoflurane can lead to a wide range of blood glucose changes, so in recent years, sevoflurane compared to propofol in laparoscopic surgery on endogenous and nitrogen oxide metabolism has been studied more and more. In this paper, a variety of research methods were used to study the phenomenon of shock and excessive anesthesia encountered by patients in the treatment process. Through observation and drug experiment of patients in different treatment courses and treatment stages, patients were asked to use sevoflurane and propofol to conduct double-blind experiments on their own drug effects. At the same time, through the long-term observation of patients with different diseases and patients who need laparoscopic surgery, the nitrogen oxide metabolism in patients with sevoflurane compared with propofol endogenous was studied and analyzed. Through three groups of different conditions, the experimental group, the blind test group, and the control group were studied. To conclude, in laparoscopic surgery, the use of sevoflurane compared with propofol can have a good impact on the endogenous drug and nitrogen oxide metabolism. It can achieve a good effect on the anesthesia effect of surgery, the maintenance of patient's physical signs and heart rate, which is very beneficial to the operation. Conclusion. Sevoflurane compared with propofol has a good effect on endogenous nitrogen oxide metabolism in laparoscopic surgery.
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Hottenrott S, Schlesinger T, Helmer P, Meybohm P, Alkatout I, Kranke P. Do Small Incisions Need Only Minimal Anesthesia?-Anesthetic Management in Laparoscopic and Robotic Surgery. J Clin Med 2020; 9:jcm9124058. [PMID: 33334057 PMCID: PMC7765538 DOI: 10.3390/jcm9124058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022] Open
Abstract
Laparoscopic techniques have established themselves as a major part of modern surgery. Their implementation in every surgical discipline has played a vital part in the reduction of perioperative morbidity and mortality. Precise robotic surgery, as an evolution of this, is shaping the present and future operating theatre that an anesthetist is facing. While incisions get smaller and the impact on the organism seems to dwindle, challenges for anesthetists do not lessen and could even become more demanding than in open procedures. This review focuses on the pathophysiological effects of contemporary laparoscopic and robotic procedures and summarizes anesthetic challenges and strategies for perioperative management.
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Affiliation(s)
- Sebastian Hottenrott
- Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (S.H.); (T.S.); (P.H.); (P.M.)
| | - Tobias Schlesinger
- Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (S.H.); (T.S.); (P.H.); (P.M.)
| | - Philipp Helmer
- Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (S.H.); (T.S.); (P.H.); (P.M.)
| | - Patrick Meybohm
- Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (S.H.); (T.S.); (P.H.); (P.M.)
| | - Ibrahim Alkatout
- Department of Gynaecology and Obstetrics, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, 24105 Kiel, Germany;
| | - Peter Kranke
- Department of Anesthesiology and Critical Care, University Hospital Wuerzburg, 97080 Wuerzburg, Germany; (S.H.); (T.S.); (P.H.); (P.M.)
- Correspondence: ; Tel.: +49-931-20130050
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Sang C, Chen X, Ren H, Meng Z, Jiang J, Qin Y. Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case-control study. BMC Surg 2020; 20:35. [PMID: 32093662 PMCID: PMC7041265 DOI: 10.1186/s12893-019-0655-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/27/2019] [Indexed: 01/05/2023] Open
Abstract
Background The aim of this study was to investigate the correlation between lumbar multifidus fat infiltration and lumbar postoperative surgical site infection (SSI). Several clinical studies have found that spine postoperative SSI is associated with age, diabetes, obesity, and multilevel surgery. However, few studies have focused on the correlation between lumbar multifidus fat infiltration and SSI. Method A retrospective review was performed on patients who underwent posterior lumbar interbody fusion (PLIF) between 2011 and 2016 at our hospital. The patients were divided into SSI and non-SSI groups. Data of risk factors [age, diabetes, obesity, body mass index (BMI), number of levels, and surgery duration] and indicators of body mass distribution (subcutaneous fat thickness and multifidus fat infiltration) were collected. The degree of multifidus fat infiltration was analyzed on magnetic resonance images using Image J. Results Univariate analysis indicated that lumbar spine postoperative SSI was associated with urinary tract infection, subcutaneous fat thickness, lumbar multifidus muscle (LMM) fat infiltration, multilevel surgery (≥2 levels), surgery duration, drainage duration, and number of drainage tubes. In addition, multiple logistic regression analysis revealed that spine SSI development was associated with sex (male), age (> 60 years), subcutaneous fat thickness, LMM fat infiltration, and drainage duration. Receiver operating characteristic curve analysis indicated that the risk of SSI development was higher when the percentage of LMM fat infiltration exceeded 29.29%. Furthermore, Pearson’s correlation analysis demonstrated that LMM fat infiltration was correlated with age but not with BMI. Conclusion Indicators of body mass distribution may better predict SSI risk than BMI following PLIF. Lumbar Multifidus fat infiltration is a novel spine-specific risk factor for SSI development.
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Affiliation(s)
- Chaohui Sang
- Department of Orthopedics, Zhuhai People's Hospital, NO. 79 Kangning Road, Zhuhai, 519000, Guangdong, China
| | - Xushi Chen
- Department of Spinal surgery, Huizhou Municipal Central Hospital, Huizhou, China
| | - Hailong Ren
- Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhandong Meng
- Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianming Jiang
- Department of Spinal Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Yi Qin
- Department of Orthopedics, Zhuhai People's Hospital, NO. 79 Kangning Road, Zhuhai, 519000, Guangdong, China.
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Zhu L, Yang B, Ma D, Wang L, Duan W. Hydrogen Sulfide, Adipose Tissue and Diabetes Mellitus. Diabetes Metab Syndr Obes 2020; 13:1873-1886. [PMID: 32581562 PMCID: PMC7276333 DOI: 10.2147/dmso.s249605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/09/2020] [Indexed: 12/30/2022] Open
Abstract
Hydrogen sulfide (H2S) is now increasingly considered to be the third gasotransmitter alongside other gaseous signaling molecules, nitric oxide (NO) and carbon monoxide (CO). H2S is produced by a variety of endogenous enzymatic and non-enzymatic pathways and acts as a modulator of the physiological and pathological events of the body. Adipocytes express the cystathionine γ lyase (CSE)/H2S system, which modulates a variety of biological activities in adipose tissue (AT), including inflammation, apoptosis, insulin resistance, adipokine secretion and adipocyte differentiation. Abnormalities in the physiological functions of AT play an important role in the process of diabetes mellitus. Therefore, this review provides an overview of the general aspects of H2S biochemistry, the effect of H2S on AT function and diabetes mellitus and its molecular signalling mechanisms as well as the potential application of H2S in pharmacotherapy.
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Affiliation(s)
- Lin Zhu
- Department of Pediatrics, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan430030, People’s Republic of China
| | - Bo Yang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430030, People’s Republic of China
| | - Dongxia Ma
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Lan Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan430030, People’s Republic of China
| | - Wu Duan
- Division of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan250012, People’s Republic of China
- Correspondence: Wu Duan Division of Endocrinology, Department of Internal Medicine, Qilu Hospital of Shandong University, Jinan250012, People’s Republic of China Tel/Fax +86-531-8692-7544 Email
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Maia LDA, Silva PL, Pelosi P, Rocco PRM. Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. Expert Rev Respir Med 2017; 11:443-452. [PMID: 28436715 DOI: 10.1080/17476348.2017.1322510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m2.
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Affiliation(s)
- Lígia de Albuquerque Maia
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Pedro Leme Silva
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,b National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
| | - Paolo Pelosi
- c Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST , University of Genoa , Genoa , Italy
| | - Patricia Rieken Macedo Rocco
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,b National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
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Abstract
Background: Roux-en-Y gastric bypass (RYGB) is considered the gold standard for gastric bypass, displaying better results for metabolic disorders than other surgical procedures over the long term. The aim of this study was to determine the effects of bariatric surgery, in particular the RYGB technique, on metabolic syndrome (MS) and other biochemical parameters implicit in the comorbid conditions associated with obesity, as well as to explore the influence of this surgical procedure on psychiatric comorbidity in the study population. Method: An observational retrospective cohort study based on 146 clinical records of patients having undergone RYGB between January 1, 2011, and January 1, 2014, was performed. Data related to metabolic and psychiatric comorbidity were gathered at three stages: prior to surgery and at 3 and 9 months following surgery. Results: There was a progressive and statistically significant reduction of all biochemical parameters analyzed at 3 and 9 months following surgery except high-density lipoprotein cholesterol, which significantly increased (beneficial) in value. These changes imply a remission of >90% for all metabolic disorders and the consequent tendency toward a reduction in prescribed pharmacological treatments, with MS found in only one subject at 9 months. There was, however, no significant reduction in pharmacological treatments for psychiatric comorbidities. Conclusion: Findings suggest that RYGB is an effective treatment for MS and other metabolic disorders but not for psychiatric comorbidities accompanying MS.
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[Specific complications of minimally invasive surgery]. Chirurg 2015; 86:1097-104. [PMID: 26541448 DOI: 10.1007/s00104-015-0105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Minimally invasive surgery (MIS) is fundamentally different from open surgery regarding positioning of the patient, access routes and instrumentation. Each of these aspects is associated with its own specific morbidity, such as positioning-related complications, trocar-induced lesions, hypercapnia-associated phenomena and thermal damage. The growing experience of surgeons and technological progress have increased patient safety to a maximum and have resulted in an impressive spread of MIS in the various fields of surgery including the most common, such as cholecystectomy and hernia repair and special fields, such as bariatric, thoracic and oncological surgery. This narrative review summarizes the current knowledge on the inherent complications of MIS.
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