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Kara YB, Ital I, Ertekin SC, Yol S, Yardimci S. Ultrasonography Guided Modified BRILMA (Blocking the Cutaneous Branches of Intercostal Nerves in the Middle Axillary Line) Block in Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2023; 33:1141-1145. [PMID: 37787937 DOI: 10.1089/lap.2023.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background: Postoperative pain is one of the major problems after laparoscopic sleeve gastrectomy besides complications. Management of pain control is still unclear in the obese population. Modified BRILMA (blocking the cutaneous branches of intercostal nerves in the middle axillary line) is a new analgesia technique which is performed by ultrasonography guided through the way between eighth and ninth rib level. This study is to evaluate the efficiency of modified BRILMA in bariatric patients while comparing with trocar site infiltration. Materials and Methods: This is a prospective designed retrospective data analysis study. Patients undergoing laparoscopic sleeve gastrectomy between June 2019 and January 2020 were divided into two groups. One group underwent BRILMA block; the other group used traditional trocar site injection. Postoperative pain was followed by using visual analogue scale (VAS) (at 1, 3, 6, 12, 24, 36, 48 hours postoperatively). Results: Thirty patients were included in the study. Twenty-four (80%) of the patients were women, and 6 (20%) of the patients were men. Mean body mass index of patients were 39.83 ± 4.02 kg/m2. Mean operational time was calculated 86.16 ± 19.94 minutes. When the patients' VAS was compared, 12th hour VAS value was statistically less in the BRILMA group. There were no significant differences in other hours' VAS between two groups. When compared with the use of opioid amount, there were no statistically significant difference between the two groups (P = .66), but BRILMA group had less amount. Conclusion: Modified BRILMA is an alternative technique to the use of trocar site bupivacain injection in bariatric surgery. It is new technique that is tried in bariatric population, which is also cost-effective and has less opioid consumption.
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Affiliation(s)
- Yalcin Burak Kara
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Istanbul, Turkey
| | - Ilker Ital
- Department of Anesthesiology, VM Medical Park Pendik Hospital, Istanbul, Turkey
| | | | - Sinan Yol
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Istanbul, Turkey
| | - Samet Yardimci
- General Surgery Department, Bahcesehir University VM Medical Park Pendik Hospital, Istanbul, Turkey
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Mahrous R, Alalfy M, Abdalgeleel SA, Abdelnasser A, Abd Elfattah DA, Hassen H, Ibrahim Ogila A, Ibrahim MA. The relation between body mass index and difficulty in inducing spinal anesthesia in elective cesarean section. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1966286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Reham Mahrous
- Department of Anesthesia, Surgical ICU, and Pain Management, Cairo University, Cairo, Egypt
- Consultant Anesthesia, Algzeera Hospital, Giza, Egypt
| | - Mahmoud Alalfy
- Reproductive Health and Family Planning Department, National Research Centre, Dokki, Egypt
- Gyn, Algezeera Hospital, Giza, Egypt
| | | | - Amr Abdelnasser
- Department of Anesthesia, Surgical ICU, and Pain Management, Cairo University, Cairo, Egypt
| | - Doaa A. Abd Elfattah
- Obstetrics and Gynecological Diseases Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hatem Hassen
- Reproductive Health and Family Planning Department, National Research Centre, Dokki, Egypt
- Gyn, Algezeera Hospital, Giza, Egypt
| | - Asmaa Ibrahim Ogila
- Obstetrics and Gynecological Diseases Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Ahmed Ibrahim
- Department of Anesthesia, Surgical ICU, and Pain Management, Cairo University, Cairo, Egypt
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Bameshki A, Khayat Kashani HR, Razavi M, Shobeiry M, Taghavi Gilani M. Comparison of the effects of 2 ventilatory strategies using tidal volumes of 6 and 8 ml/kg on pulmonary shunt and alveolar dead space volume in upper abdominal cancers surgery. Med J Islam Repub Iran 2021; 35:79. [PMID: 34291003 PMCID: PMC8285548 DOI: 10.47176/mjiri.35.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Indexed: 11/11/2022] Open
Abstract
Background: High tidal volume leads to inflammation, and low tidal volume leads to atelectasia and hypoxemia. This study was conducted to compare the effect of 6 mL/kg with positive end-expiratory pressure (PEEP) and 8 mL/kg without PEEP on pulmonary shunt and dead space volume.
Methods: This clinical trial was done on 36 patients aged 20 to 65 years old with ASA I-II. They were candidates for upper abdominal surgery and divided randomly into 2 groups. One group were ventilated with the tidal volume = 8 mL/kg without PEEP (TV8). The other group received the tidal volume = 6 mL/kg with low PEEP = 5 cm H2O (TV6). Arterial and central venous blood gases were taken after intubation and 2 hours later. Additionally, the vital signs of the patients were checked every 30 minutes. Data analysis was performed using t test, chi-square test, and repeated measures analysis of variance with SPSS software, version 16 (SPSS Inc). P value less than.05 were meaningful.
Results: There was no significant difference on the preanesthesia parameters. The pulmonary shunt was 13.5±0.1% and 18.6±0.2% in the groups TV6 and TV8, respectively (p=0.132), which slightly decreased after 2 hours in both groups without any significant difference (p=0.284). Prior to the ventilation, the ratios of dead space to tidal volume were 0.25±0.2 and 0.14±0.1 in the TV6 and TV8 groups, respectively (p=0.163), and after 2 hours, they were 0.23±0.11 and 0.16±0.1 in the TV6 and TV8 groups, respectively (p=0.271). There was no significant difference between the groups for blood pressure and peripheral and arterial oxygenation changes.
Conclusion: The tidal volume of 6 mL/kg with the PEEP of 5 mmHg was similar to the tidal volume of 8 mL/kg without PEEP for hemodynamic and pulmonary changes (oxygenation, shunt, and dead space).
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Affiliation(s)
- Alireza Bameshki
- Lung Disease Research Center, Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Majid Razavi
- Lung Disease Research Center, Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Shobeiry
- Lung Disease Research Center, Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehryar Taghavi Gilani
- Lung Disease Research Center, Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
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El Moheb M, Jia Z, Qin H, El Hechi MW, Nordestgaard AT, Lee JM, Han K, Kaafarani HMA. The Obesity Paradox in Elderly Patients Undergoing Emergency Surgery: A Nationwide Analysis. J Surg Res 2021; 265:195-203. [PMID: 33951584 DOI: 10.1016/j.jss.2021.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/15/2021] [Accepted: 02/27/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity has long been considered a risk factor for postoperative adverse events in surgery. We sought to study the impact of body mass index (BMI) on the clinical outcomes of the high-risk emergency general surgery (EGS) elderly patients. METHODS All EGS ≥65 years old patients in the 2007-2016 ACS-NSQIP database, identified using the variables 'emergency' and 'surgspec,' were included. Patients were classified into five groups: normal weight: BMI <25 kg/m2, overweight: BMI ≥25 kg/m2 and <30 kg/m2, Class I: BMI ≥30 kg/m2 and <35 kg/m2, Class II: BMI ≥35 kg/m2 and <40 kg/m2, and Class III: BMI ≥40 kg/m2. Patients with BMI<18.5 kg/m2 were excluded. Multivariable logistic regression models were built to assess the relationship between obesity and 30-day postoperative mortality, overall morbidity, and individual postoperative complications after adjusting for demographics (e.g., age, gender), comorbidities (e.g., diabetes mellitus, heart failure), laboratory tests (e.g., white blood cell count, albumin), and operative complexity (e.g., ASA classification). RESULTS A total of 78,704 patients were included, of which 26,011 were overweight (33.1%), 13,897 (17.6%) had Class I obesity, 5904 (7.5%) had Class II obesity, and 4490 (5.7%) had Class III obesity. On multivariable analyses, compared to the nonobese, patients who are overweight or with Class I-III obesity paradoxically had a lower risk of mortality, bleeding requiring transfusion, pneumonia, stroke and myocardial infarction (MI). Additionally, the incidence of MI and stroke decreased in a stepwise fashion as BMI progressed from overweight to severely obese (MI: OR: 0.84 [0.73-0.95], OR: 0.73 [0.62-0.86], OR: 0.66 [0.52-0.83], OR: 0.51 [0.38-0.68]; stroke: OR: 0.80 [0.65-0.99], OR: 0.79 [0.62-1.02], OR: 0.71 [0.50-1.00], OR: 0.43 [0.28-0.68]). CONCLUSION In our study of elderly EGS patients, overweight and obese patients had a lower risk of mortality, bleeding requiring transfusion, pneumonia, reintubation, stroke, and MI. Further studies are needed to confirm and investigate the obesity paradox in this patient population.
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Affiliation(s)
- Mohamad El Moheb
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Zhenyi Jia
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Department of General Surgery, Shanghai Sixth People's hospital affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Huanlong Qin
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Majed W El Hechi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Ask T Nordestgaard
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesia, Centre of Head and Orthopaedics 4231, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jae Moo Lee
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Kelsey Han
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
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Cho A, So J, Ko EY, Choi D. Spinal anesthesia for cesarean section in a super morbidly obese parturient: A case report. Medicine (Baltimore) 2020; 99:e21435. [PMID: 32756154 PMCID: PMC7402778 DOI: 10.1097/md.0000000000021435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 06/01/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The population of obese individuals is increasing worldwide, and as a result, the number of mothers with super morbid obesity undergoing cesarean sections is also increasing. However, little is known about which anesthetic technique is appropriate for cesarean sections of super morbidly obese parturients. PATIENT CONCERNS A 35-year-old woman with body mass index 61.3 kg/m at a gestational age of 37 weeks. DIAGNOSIS The patient was super morbidly obese parturient. INTERVENTIONS Spinal anesthesia was performed. A spinal needle was inserted into the L4-5 interspinous space in the sitting position. After confirmation of cerebrospinal fluid, 0.5% hyperbaric bupivacaine 9 mg and fentanyl 20 μg were injected into the subarachnoid space. OUTCOMES After the administration of spinal anesthetics, the nerve block to the T8 dermatome level was confirmed, surgery was performed, and the fetus was delivered. The patient's vital signs were stable until the end of the operation. CONCLUSION There is no established strategy for selecting a method of anesthesia in patients with morbid obesity (body mass index 40 kg/m or more). For this reason and considering the amount of bupivacaine used for spinal anesthesia, we wanted to share our experience with spinal anesthesia for cesarean section in a super morbidly obese parturients.
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MESH Headings
- Adult
- Analgesics, Opioid/administration & dosage
- Anesthesia, Epidural/methods
- Anesthesia, Obstetrical/methods
- Anesthesia, Obstetrical/trends
- Anesthesia, Spinal/instrumentation
- Anesthesia, Spinal/methods
- Anesthetics, Local/administration & dosage
- Body Mass Index
- Bupivacaine/administration & dosage
- Cesarean Section/methods
- Female
- Fentanyl/administration & dosage
- Gestational Age
- Humans
- Injections, Spinal
- Needles
- Obesity, Morbid/epidemiology
- Obesity, Morbid/surgery
- Patient Discharge/standards
- Pregnancy
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Ciftci B, Ekinci M, Celik EC, Kaciroglu A, Karakaya MA, Demiraran Y, Ozdenkaya Y. Comparison of Intravenous Ibuprofen and Paracetamol for Postoperative Pain Management after Laparoscopic Sleeve Gastrectomy. A Randomized Controlled Study. Obes Surg 2020; 29:765-770. [PMID: 30474791 DOI: 10.1007/s11695-018-3613-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is defined as the first-step bariatric surgery for the treatment of obesity. Opioid analgesics are often preferred for pain management because of their strong analgesic potentials. However, opioids have undesirable adverse effects. OBJECTIVES The objective of this study is to evaluate and compare the influence of IV forms of ibuprofen and paracetamol on pain management and opioid consumption on patients undergoing LSG surgery. SETTING This study was conducted at Istanbul Medipol University Hospital. METHODS Patients were stratified into three groups. Group I (group ibuprofen, n = 30) was administered 800 mg of IV ibuprofen, group P (group paracetamol, n = 30) was administered 1000 mg of IV paracetamol, and group C (control group, n = 30) was given 100 ml of saline solution. We evaluated opioid consumption and VAS scores postoperatively. RESULTS This study included 90 patients who underwent LSG. The use of rescue medication in group I was statistically lower than the other groups. VAS scores in group I and group P at recovery and at 2, 4, 8, 12, and 24 h were lower than those in group C. In particular, the VAS scores in group I at the first 2 h postoperatively were significantly lower than those in group P (p < 0.05). Opioid consumption in group C was significantly higher than the other groups (p < 0.05). CONCLUSION Our study suggested that IV ibuprofen resulted in lower pain scores compared to paracetamol by reducing postoperative opioid use in the first 24 h in patients undergoing LSG surgery.
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Affiliation(s)
- Bahadır Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey.
| | - Mursel Ekinci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
| | - Erkan Cem Celik
- Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Yakutiye, 25070, Erzurum, Turkey
| | - Ahmet Kaciroglu
- Department of Anesthesiology and Reanimation, Fatih Sultan Mehmet Training and Research Hospital, Merkez, 34000, Istanbul, Turkey
| | - Muhammet Ahmet Karakaya
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
| | - Yavuz Demiraran
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
| | - Yasar Ozdenkaya
- Department of General Surgery, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
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Pazzianotto-Forti EM, Baltieri L, Brigatto P, Costa CMD, Rocha MRSD, Rasera-Júnior I. Bilevel positive airway pressure in two moments after bariatric surgery. ACTA ACUST UNITED AC 2019; 65:1161-1167. [PMID: 31618331 DOI: 10.1590/1806-9282.65.9.1161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/02/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN Randomized and blinded clinical trial. METHODS We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). CONCLUSION Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.
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Affiliation(s)
- Eli Maria Pazzianotto-Forti
- . Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Letícia Baltieri
- . Doutorado em Ciências da Cirurgia, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brasil
| | - Patrícia Brigatto
- . Mestrado em Fisioterapia, Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Carolina Moraes da Costa
- . Mestrado em Fisioterapia, Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Maura Rigoldi Simões da Rocha
- . Mestrado em Fisioterapia, Programa de Pós-Graduação em Ciências do Movimento Humano, Universidade Metodista de Piracicaba, Unimep, Piracicaba, SP, Brasil
| | - Irineu Rasera-Júnior
- . Doutorado em Bases Gerais da Cirurgia, Centro de Gastroenterologia e Cirurgia da Obesidade, Piracicaba, SP, Brasil
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A Multimodal Analgesic Protocol Reduces Opioid-Related Adverse Events and Improves Patient Outcomes in Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 27:3075-3081. [PMID: 28674840 DOI: 10.1007/s11695-017-2790-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed procedures for the treatment of obesity. Patients with obesity are more prone to experience opioid-related adverse events (ORAE). OBJECTIVES The objective of this study is to determine if a multimodal analgesia protocol (MAP) reduces ORAE and provides effective pain relief for patients after LSG. SETTING This study was conducted at University Hospital, Singapore. METHODS The MAP consists of mandatory pre-operative etoricoxib, intra-operative acetaminophen, and post-operative acetaminophen with optional post-operative tramadol. We identified and collected data for patients who underwent LSG between May 2010 and November 2015 and compared patients before and after the implementation of the MAP. RESULTS One hundred fifty-eight patients were included and 68 patients were treated with the MAP. There were no differences in age, gender, body mass index, ethnicity, or comorbidities between the two groups except for the incidence of hypertension (p = 0.015). There was a significant reduction in the incidence of ORAE from 33.3 to 8.8% (p < 0.001) after the implementation of the MAP. There was also a significant reduction in the use of opioids intra-operatively from 58.2 to 43.6 mg (p < 0.001) and post-operatively from 23.7 to 0.7 mg (p < 0.001). Pain scores were similar at 1, 6, and 48 post-operatively, while pain scores were significantly reduced at 12 (p = 0.033) and 24 h (p = 0.02) post-operatively. Multivariate analysis showed that these results remained significant. CONCLUSION Our study suggests that a MAP reduces ORAE and provides effective pain relief for patients undergoing LSG.
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Davies HO, Popplewell M, Singhal R, Smith N, Bradbury AW. Obesity and lower limb venous disease - The epidemic of phlebesity. Phlebology 2016; 32:227-233. [PMID: 27178403 DOI: 10.1177/0268355516649333] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction Lower limb venous disease affects up to one half, and obesity up to one quarter, of the adult population. Many people are therefore affected by, and present to health services for the treatment of both conditions. This article reviews the available evidence of pathophysiological and clinical relationship between obesity and varicose veins, chronic venous insufficiency and ulceration and deep vein thrombosis. Methods A literature search of PubMed and Cochrane libraries was performed in accordance with PRISMA statement from 1946 to 2015, with further article identification from following cited references for articles examining the relationship between obesity and venous disease. Search terms included obesity, overweight, thrombosis, varicose veins, CEAP, chronic venous insufficiency, treatment, endovenous, endothermal, sclerotherapy, bariatric surgery and deep vein thrombosis. Results The proportion of the population suffering from lower limb venous disease and obesity is increasing. Obesity is an important risk factor for all types of lower limb venous disease, and obese patients with lower limb venous disease are more likely to be symptomatic as a result of their lower limb venous disease. The clinical diagnosis, investigation, imaging and treatment of lower limb venous disease in obese people present a number of challenges. The evidence base underpinning medical, surgical and endovenous management of lower limb venous disease in obese people is limited and such treatment may be associated with worse outcomes and increased risks when compared to patients with a normal body mass index. Conclusion Lower limb venous disease and obesity are both increasingly common. As such, phlebologists will be treating ever greater numbers of obese patients with lower limb venous disease, and clinicians in many other specialties are going to be treating a wide range of obesity-related health problems in people with or at risk of lower limb venous disease. Unfortunately, obese people have been specifically excluded from many, if not most, of the pivotal studies. As such, many basic questions remain unanswered and there is an urgent need for research in this challenging and increasingly prevalent patient group.
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Affiliation(s)
- Huw Ob Davies
- 1 University Department of Vascular Surgery, Heartlands Hospital, Birmingham, UK
| | - Matthew Popplewell
- 1 University Department of Vascular Surgery, Heartlands Hospital, Birmingham, UK
| | - Rishi Singhal
- 2 Department of Upper Gastro-Intestinal and Bariatric Surgery, Heartlands Hospital, Birmingham, UK
| | - Neil Smith
- 3 Department of Haematology, Heartlands Hospital, Birmingham, UK
| | - Andrew W Bradbury
- 1 University Department of Vascular Surgery, Heartlands Hospital, Birmingham, UK
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10
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Saghazadeh A, Rezaei N. Inflammation as a cause of venous thromboembolism. Crit Rev Oncol Hematol 2016; 99:272-85. [DOI: 10.1016/j.critrevonc.2016.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 11/27/2015] [Accepted: 01/12/2016] [Indexed: 12/12/2022] Open
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11
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Baltieri L, Santos LA, Rasera I, Montebelo MIL, Pazzianotto-Forti EM. Use of positive pressure in the bariatric surgery and effects on pulmonary function and prevalence of atelectasis: randomized and blinded clinical trial. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27 Suppl 1:26-30. [PMID: 25409961 PMCID: PMC4743514 DOI: 10.1590/s0102-6720201400s100007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/13/2014] [Indexed: 01/07/2023]
Abstract
Background In surgical procedures, obesity is a risk factor for the onset of intra and
postoperative respiratory complications. Aim Determine what moment of application of positive pressure brings better benefits
on lung function, incidence of atelectasis and diaphragmatic excursion, in the
preoperative, intraoperative or immediate postoperative period. Method Randomized, controlled, blinded study, conducted in a hospital and included
subjects with BMI between 40 and 55 kg/m2, 25 and 55 years, underwent
bariatric surgery by laparotomy. They were underwent preoperative and
postoperative evaluations. They were allocated into four different groups: 1)
Gpre: treated with positive pressure in the BiPAP mode (Bi-Level Positive Airway
Pressure) before surgery for one hour; 2) Gpos: BIPAP after surgery for one hour;
3) Gintra: PEEP (Positive End Expiratory Pressure) at 10 cmH2O during
the surgery; 4) Gcontrol: only conventional respiratory physiotherapy. The
evaluation consisted of anthropometric data, pulmonary function tests and chest
radiography. Results Were allocated 40 patients, 10 in each group. There were significant differences
for the expiratory reserve volume and percentage of the predicted expiratory
reserve volume, in which the groups that received treatment showed a smaller loss
in expiratory reserve volume from the preoperative to postoperative stages. The
postoperative radiographic analysis showed a 25% prevalence of atelectasis for
Gcontrol, 11.1% for Gintra, 10% for Gpre, and 0% for Gpos. There was no
significant difference in diaphragmatic mobility amongst the groups. Conclusion The optimal time of application of positive pressure is in the immediate
postoperative period, immediately after extubation, because it reduces the
incidence of atelectasis and there is reduction of loss of expiratory reserve
volume.
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Affiliation(s)
| | | | - Irineu Rasera
- Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil
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Moncada R, Martinaitis L, Landecho M, Rotellar F, Sanchez-Justicia C, Bellver M, de la Higuera M, Silva C, Osés B, Martín E, Pérez S, Hernandez-Lizoain JL, Frühbeck G, Valentí V. Does Preincisional Infiltration with Bupivacaine Reduce Postoperative Pain in Laparoscopic Bariatric Surgery? Obes Surg 2015; 26:282-8. [DOI: 10.1007/s11695-015-1761-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Andersen LPH, Werner MU, Rosenberg J, Gögenur I. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery: a Systematic Review of Randomized Trials. Obes Surg 2014; 24:462-70. [DOI: 10.1007/s11695-013-1172-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Irwin AN, McCool KH, Delate T, Witt DM. Assessment of warfarin dosing requirements after bariatric surgery in patients requiring long-term warfarin therapy. Pharmacotherapy 2013; 33:1175-83. [PMID: 23744816 DOI: 10.1002/phar.1307] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY OBJECTIVE To quantify the change in weekly warfarin dose after bariatric surgery in patients requiring long-term warfarin therapy. DESIGN Retrospective matched-cohort study. SETTING Anticoagulation management service in an integrated health care delivery system. PATIENTS Patients receiving long-term warfarin anticoagulation who underwent bariatric surgery between January 1, 1996, and December 31, 2010 (27 patients), were matched by date of surgery (± 2 years), age (± 5 years), and target international normalized ratio (INR) range to patients receiving long-term anticoagulation therapy who underwent other abdominal surgical procedures: cholecystectomy or endoscopic retrograde cholangiopancreatography (59 patients [control group]). MEASUREMENT AND MAIN RESULTS The main end point was change in postoperative warfarin dose from baseline (preoperative dose), measured at weekly postoperative intervals from weeks 1 to 8 and again at months 3 and 6. After surgery, patients in the bariatric surgery group had statistically significant decreases in weekly warfarin doses compared with preoperative dose at all postoperative time points (week 1 dose vs preoperative dose, p<0.01; doses at all other time points vs preoperative dose, p<0.001), except at 6 months (p>0.05). No statistically significant decreases in warfarin dose were detected at any postoperative time points in the control group. Twenty patients (74.1%) in the bariatric surgery group experienced a 20% or more decrease in weekly warfarin dose compared with 19 patients (32.2%) in the control group (p=0.004). No significant differences in warfarin-related adverse events were noted between groups. CONCLUSION Weekly warfarin doses decreased in the immediate postoperative period in anticoagulated patients after bariatric surgery but returned to their preoperative doses after approximately 6 months. A similar pattern was not observed in patients in the control group who underwent other types of abdominal surgery. Compared with preoperative anticoagulation control, this resulted in reduced anticoagulation control despite close INR monitoring. If a causal relationship between bariatric surgery and warfarin sensitivity is established in future research, developing and validating a postbariatric surgery warfarin-dosing algorithm would be valuable.
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Affiliation(s)
- Adriane N Irwin
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado, USA
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Abstract
The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical care concerns in critically ill obese patients.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Vishal Sehgal
- Department of Internal Medicine, The Commonwealth Medical College Scranton, PA 18510, USA
| | - Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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Hurt RT, Frazier TH, McClave SA, Cave MC. Pharmaconutrition for the Obese, Critically Ill Patient. JPEN J Parenter Enteral Nutr 2011; 35:60S-72S. [DOI: 10.1177/0148607111413775] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ryan T. Hurt
- Department of Medicine
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas H. Frazier
- Department of Medicine
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky
| | - Stephen A. McClave
- Department of Medicine
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky
| | - Matt C. Cave
- Department of Medicine
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky
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Abstract
Achieving pain control in critically ill patients is a challenging problem for the health care team, which becomes more challenging in morbidly obese patients. Obese patients may experience drug malabsorption and distribution, which may lead to either subtherapeutic or toxic drug levels. To manage pain effectively for the critically ill obese patient, nurses must have an understanding of how obesity alters a patient's physiologic response to injury and illness. In addition, nurses must be knowledgeable about physiologic pain mechanisms, types and manifestations of pain, differing patterns of drug absorption and distribution, pharmacokinetic properties of analgesic medications, and pain management strategies. This article explores factors affecting pharmacokinetics in obese patients, trends in pain management, and treatment strategies for the obese patient.
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Affiliation(s)
- Sonia M Astle
- Department of Critical Care, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
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Wong DT, Adly E, Ip HYV, Thapar S, Maxted GR, Chung FF. A comparison between the Boussignac™ continuous positive airway pressure mask and the venturi mask in terms of improvement in the PaO2/F(I)O2 ratio in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial. Can J Anaesth 2011; 58:532-9. [PMID: 21465320 DOI: 10.1007/s12630-011-9497-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study compared the Boussignac™ continuous positive airway pressure (CPAP) mask with the venturi face mask in terms of the postoperative PaO2/F(I)O2 (PF) ratio in morbidly obese patients after bariatric surgery. METHODS Following hospital Research Ethics Board approval and written informed consent, morbidly obese (body mass index > 35 kg·m(-2)) patients undergoing bariatric surgery were recruited. The patients were anesthetized and laparoscopic Roux-en-Y gastric bypass was performed. Patients were assigned randomly to receive either the Boussignac (Boussignac Group) or the venturi face mask (Venturi Group) immediately after tracheal extubation. Patients were transported to the postanesthesia care unit, and the respective devices were applied for one hour. The PF ratio was recorded after tracheal intubation and at one hour and two hours post extubation. The percent forced expiratory volume (%FEV1) and the percent forced vital capacity (%FVC) were recorded preoperatively and at one hour and two hours post extubation. Independent Student's t tests were used for continuous variables, and the Chi square test was used for categorical variables. P < 0.05 was considered statistically significant. RESULTS Eighty-one patients (Group Boussignac, n = 43; Group Venturi, n = 38) completed the study. Mean ages and body mass indices were similar in the two groups. At one hour post extubation, the PF ratio in the Boussignac Group was 361 (170) compared with 279 (91) in the Venturi Group (P = 0.007), and at two hours post extubation, the PF ratio in the Boussignac Group was 371 (162) compared with 323 (127) in the Venturi Group (P = 0.1). The postoperative %FEV(1) and %FVC were comparable in both groups at all time points. CONCLUSION Compared with the venturi mask, the Boussignac CPAP mask improves the postoperative PF ratio in morbidly obese patients after bariatric surgery. The postoperative %FEV1 and %FVC are comparable for both groups.
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Affiliation(s)
- David T Wong
- Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St., MC2-405, Toronto, ON, M5T 2S8, Canada.
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19
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Westerly BD, Dabbagh O. Morbidity and mortality characteristics of morbidly obese patients admitted to hospital and intensive care units. J Crit Care 2011; 26:180-5. [DOI: 10.1016/j.jcrc.2010.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 12/20/2022]
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21
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) 2009; 17 Suppl 1:S1-70, v. [PMID: 19319140 DOI: 10.1038/oby.2009.28] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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22
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract 2008; 14 Suppl 1:1-83. [PMID: 18723418 DOI: 10.4158/ep.14.s1.1] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 2008; 4:S109-84. [PMID: 18848315 DOI: 10.1016/j.soard.2008.08.009] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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24
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McDonnell NJ, Paech MJ. The management of a super morbidly obese parturient delivering twins by caesarean section. Anaesth Intensive Care 2008; 35:979-83. [PMID: 18084995 DOI: 10.1177/0310057x0703500622] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A super morbidly obese (230 kg, body mass index 76 kg/m2) patient presented to our service for a planned elective caesarean section for twin delivery. She subsequently underwent a non-elective caesarean section after normal working hours under combined spinal epidural anaesthesia with invasive monitoring. Complex cases such as this, especially in the obstetric setting, require thorough multidisciplinary planning, communication and expertise but can be safely and successfully performed in dedicated stand-alone centres.
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Affiliation(s)
- N J McDonnell
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
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25
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Gaszynski T, Tokarz A, Piotrowski D, Machala W. Boussignac CPAP in the postoperative period in morbidly obese patients. Obes Surg 2007; 17:452-6. [PMID: 17608255 DOI: 10.1007/s11695-007-9079-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the postoperative period hypoventilation and hypoxia with hypercarbia may occur in morbidly obese patients due to the residual influence of general anesthesia drugs, postoperative atelectasis and postoperative pain. Non-Invasive Ventilation (NIV) is a method of improvement of respiratory efficiency in patients not requiring mechanical ventilation. The aim of the study was to compare NIV (Boussignac) CPAP and traditional oxygen delivery via nasal catheter in the postoperative acute care unit (PACU) in morbidly obese patients after open Roux-en-Y gastric bypass (RYGBP). METHODS 19 morbidly obese patients scheduled for elective open RYGBP, were randomly divided into 2 groups: CPAP (10 patients) or control (nasal catheter - 9 patients). Patients consisted of: 8 male and 11 female, mean weight 127.76 +/- 18.5 kg, height 173.41 +/- 9.41 cm, BMI 42.43 +/- 3.3 kg/m2, age 35.84 +/- 9.05 years. In the PACU, capillary blood gas measurements were taken at 3 Time Points: T1 - 30 min, T2 - 4 hours and T3 - 8 hours after admission. Sample T0 was taken before surgery. For management of postoperative pain, patients received morphine 2 mg/h intravenously and tramadol 100 mg. RESULTS Mean blood gas measurements of all postoperative time points were: pO2 81.0+/-16.0 (range 78.1-85.7) mmHg vs 65.9+/-4.9 (range 63.8-68.1) mmHg (P<0.05); pCO2 40.6+/-2.4 (range 39.4-41.8) mmHg vs 41.5+/-4.0 (range 39.6-43.4) mmHg (P>0.05), in the CPAP and control groups respectively. In every case, pulse-oxymetry oxygenation was >94%. CONCLUSION Boussignac CPAP improved blood oxygenation compared to passive oxygenation with a nasal catheter but had no influence on CO2 elimination in non-CO2 retaining morbidly obese patients.
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Affiliation(s)
- Tomasz Gaszynski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Poland.
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26
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Kira S, Koga H, Yamamoto S, Takeshima N, Hasegawa A, Miyakawa H, Noguchi T. Anesthetic management of laparoscopic adjustable gastric banding in Japanese patients with morbid obesity. J Anesth 2007; 21:424-8. [PMID: 17680200 DOI: 10.1007/s00540-007-0529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 03/22/2007] [Indexed: 10/23/2022]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is a common type of bariatric surgery worldwide, though not so in Japan. Here we report the anesthetic management of LAGB in ten Japanese patients with morbid obesity. General anesthesia was induced with propofol, fentanyl, and vecuronium bromide and maintained with sevoflurane in oxygen and air (or nitrous oxide in some cases). In a limited number of patients, perioperative epidural analgesia was performed, with fentanyl injected intravenously for analgesia in the remaining patients. Although some special considerations were needed, in perioperative management, including thromboprophylaxis, there were no severe complications in any of the patients.
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Affiliation(s)
- Shinichiro Kira
- Department of Anesthesiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593, Japan
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Abstract
PURPOSE OF REVIEW The number of obese patients undergoing anesthesia and surgery is increasing. This article aims to present recent achievements in the management of gross and morbidly obese patients in order to improve safety. RECENT FINDINGS Current investigations have demonstrated that the type of anesthesia (total intravenous anesthesia or volatile) and the anesthetics used have an important influence on the perioperative period, especially on postanesthesia recovery and respiratory failure during the postoperative period. These findings were compared with previous publications. Practical advice is also presented for performing successful intubation and mechanical ventilation in the morbidly obese patient, as well as describing drug dosage and administration. SUMMARY The progress in anesthesia techniques and modern drugs allows for safe management of obese patients, with mortality decreasing in this group of patients.
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Affiliation(s)
- Tomasz Gaszynski
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Poland.
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Zuelzer HB, Baugh NG. Bariatric and body-contouring surgery: a continuum of care for excess and lax skin. Plast Surg Nurs 2007; 27:3-13; quiz 14-5. [PMID: 17356449 DOI: 10.1097/01.psn.0000264157.22882.d1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obesity continues to reach epidemic proportions in the United States, with more than 60% of Americans classified as obese. Correspondingly, the number of individuals undergoing bariatric surgery has increased dramatically. There are several bariatric procedures that may be performed, with laparoscopic adjusted gastric band (LABG) the newest. Following bariatric surgery and massive weight loss, patients may be left with problematic loose, hanging skin. The loose or redundant skin may occur on the abdomen, back, upper arms, and inner and outer thighs. Body-contouring surgery may be performed to correct the residual excess tissues. Prebariatric planning for plastic surgery to correct skin defects, as well as postoperative bariatric and body-contouring care, is discussed.
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Affiliation(s)
- Helen B Zuelzer
- Division of Plastic & Reconstructive Surgery, Virginia Commonwealth University Medical Center, PO Box 980154, Richmond, VA 23298, USA.
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Brown CVR, Velmahos GC. The consequences of obesity on trauma, emergency surgery, and surgical critical care. World J Emerg Surg 2006; 1:27. [PMID: 16953896 PMCID: PMC1586188 DOI: 10.1186/1749-7922-1-27] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Accepted: 09/06/2006] [Indexed: 11/10/2022] Open
Abstract
The era of the acute care surgeon has arrived and this "new" specialty will be expected to provide trauma care, emergency surgery, and surgical critical care to a variety of patients arriving at their institution. With the exception of practicing bariatric surgeons, many general surgeons have limited experience caring for obese patients. Obese patients manifest unique physiology and pathophysiology, which can influence a surgeon's decision-making process. Following trauma, obese patients sustain different injuries than lean patients and have worse outcomes. Emergency surgery diseases may be difficult to diagnose in the obese patient and obesity is associated with increased complications in the postoperative patient. Caring for an obese patient in the surgical ICU presents a distinctive challenge and may require alterations in care. The following review should act as an overview of the pathophysiology of obesity and how obesity modifies the care of trauma, emergency surgery, and surgical critical care patients.
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Affiliation(s)
- Carlos VR Brown
- Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine, Los Angeles County/University of Southern California Medical Center, Los Angeles, California, USA
| | - George C Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Heffline MS. Preventing vascular complications after gastric bypass. JOURNAL OF VASCULAR NURSING 2006; 24:50-4; quiz 55. [PMID: 16737930 DOI: 10.1016/j.jvn.2006.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 01/31/2006] [Accepted: 02/01/2006] [Indexed: 11/30/2022]
Abstract
As the problem of morbid obesity has increased over the past several years in the United States, gastric bypass has become a viable option for many people seeking treatment. The risk of a venous thromboembolic event after gastric bypass is significant and linked to several factors. As the gastric bypass program at this southeastern hospital progressed, the number of thromboembolic complications increased. Because of the increase in postoperative thromboembolic events, a program was developed to improve outcomes and reduce the number of these events. The program currently uses a protocol that includes research-based preventive measures in conjunction with warfarin (Coumadin, Bristol Myers Squibb, Princeton, NJ) 1 mg daily for 30 days postoperatively with a target international normalized ratio of 1.8 or less. Before the initiation of the program, the event rate was 6.9%. The event rate for the evaluation period after initiation of the protocol was 1.3%. Further studies are needed to determine the full benefit of this type of program and whether the improvements gained were related to the use of warfarin (Coumadin).
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Affiliation(s)
- Melody S Heffline
- Vascular Surgery and Anticoagulation Clinic, Southern Surgical Group, West Columbia, South Carolina, USA
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Abstract
OBJECTIVE To synthesize the current literature on care of obese, critically ill, and bariatric surgical patients. DATA SOURCE A MEDLINE/PubMed search from 1966 to August 2005 was conducted using the search terms obesity, bariatric surgery, and critical illness, and a search of the Cochrane Library was also conducted. DATA EXTRACTION AND SYNTHESIS An increase in both the prevalence of obesity and the number of bariatric procedures performed has resulted in an increased number of obese and, specifically, bariatric surgical patients who require intensive care unit care. Obesity is a chronic inflammatory state with resultant effects on immune, metabolic, respiratory, cardiovascular, gastrointestinal, hematologic, and renal function. Principles of care of the critically ill obese patient are reviewed and then applied to critically ill bariatric surgical patients. Pharmacotherapy, vascular access, and the presentation and management of both pressure-induced rhabdomyolysis and anastomotic failure after bariatric surgery are also reviewed. CONCLUSIONS Obesity causes a range of pathologic effects on all major organ systems. Knowledge of these effects and issues specific to the intensive care unit care of bariatric patients can help to predict and manage complications in this population.
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Affiliation(s)
- Fredric M Pieracci
- Department of Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA
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Marley RA, Hoyle B, Ries C. Perianesthesia respiratory care of the bariatric patient. J Perianesth Nurs 2006; 20:404-31; quiz 432-4. [PMID: 16387272 DOI: 10.1016/j.jopan.2005.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our nation's obesity problem has reached epidemic proportions and is only projected to worsen. The morbidly obese patient is at risk for experiencing a multitude of health-related conditions. Morbidly obese patients are presenting for surgery at an increasing rate, especially with the growing popularity of weight-loss surgery. Therefore the perianesthesia nurse has to remain informed of optimal care strategies for this sometimes challenging population. The obese patient presents with distinct respiratory care considerations of which the perianesthesia nurse must be knowledgeable. This review article will specifically focus on the respiratory care of the bariatric patient presenting for surgery.
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Affiliation(s)
- Rex A Marley
- Northwestern Colorado Anesthesia Professional Consultants, Fort Collins, CO 80524, USA.
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Hillingsø JG, Wettergren A, Hyoudo M, Kirkegaard P. Obesity increases mortality in liver transplantation--the Danish experience. Transpl Int 2005; 18:1231-5. [PMID: 16221152 DOI: 10.1111/j.1432-2277.2005.00206.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obesity is increasing in the western world at an epidemic rate. The USA results in obese patients undergoing orthotopic liver transplantation (OLT) are divergent, and so far no European experience has been reported. This study was designed to determine if obesity is a risk factor for mortality and morbidity in OLT in a medium-size European center. In a retrospective study of the records of 365 consecutive patients who had undergone OLT from 1990 to 2003, 20 obese patients [body mass index (BMI) > 30 kg/m2] were identified. Their data were compared with those of the nonobese (BMI < 30 kg/m2) patients operated immediately before. There were no differences in demographic data, diagnosis leading to OLT, United Network of Organ Sharing (UNOS) classification, Child-Pugh score, or preoperative morbidity. The groups were also comparable concerning donor data, duration of operation, use of blood products, intensive care unit (ICU), or hospital admission. Mortality was, however, significantly increased in the obese group (P = 0.01). Our study clearly demonstrates an increased mortality in obese patients undergoing OLT and the relative scarcity of organs taken into account, it seems reasonable to consider obesity as a relative contraindication to OLT.
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Affiliation(s)
- Jens G Hillingsø
- Department of Surgical, Gastroenterology, and Liver Transplantation, Center of Abdominal Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Abstract
The current epidemic of obesity and its myriad comorbidities represents one of the true major public health crises in the United States today. Data reflecting durable weight loss achieved through surgical treatment of obesity demonstrate impressive results heretofore unattainable with less aggressive modalities. However, these outcomes are accompanied by expected side effects and complications, which require specific knowledge to diagnose accurately and a specialized skill-set to manage precisely. With the ever-increasing demand for bariatric surgery, the number of ensuing complications will also rise, requiring the expertise of a gastroenterologist for both diagnosis and treatment. Thus, the gastroenterologist must develop a keen understanding of bariatric surgical anatomy and physiology, as well as the expected postoperative side effects and potential complications experienced by the post-bariatric patient.
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Affiliation(s)
- John A Martin
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1400, Chicago, IL 60611, USA
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Sarani B, Chun A, Venbrux A. Role of Optional (Retrievable) IVC Filters in Surgical Patients at Risk for Venous Thromboembolic Disease. J Am Coll Surg 2005; 201:957-64. [PMID: 16310701 DOI: 10.1016/j.jamcollsurg.2005.07.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 07/25/2005] [Accepted: 07/26/2005] [Indexed: 11/15/2022]
Affiliation(s)
- Babak Sarani
- Department of Surgery, The George Washington University, Washington, DC, USA
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Paisani DDM, Chiavegato LD, Faresin SM. Volumes, capacidades pulmonares e força muscular respiratória no pós-operatório de gastroplastia. J Bras Pneumol 2005. [DOI: 10.1590/s1806-37132005000200007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A gastroplastia tem sido cada vez mais indicada no tratamento de obesos mórbidos, pacientes nos quais podemos identificar alteração pronunciada de volumes e capacidades pulmonares. OBJETIVO: Avaliar o comportamento dos volumes e capacidades pulmonares, força muscular respiratória, padrão respiratório e as possíveis complicações pulmonares pós-operatórias. MÉTODO: Vinte e um pacientes (três homens) com média de idade de 39 ± 9,7 anos, média de índice de massa corpórea de 50,4 Kg/m², candidatos à gastroplastia, foram avaliados no pré-operatório, primeiro, terceiro e quinto dias de pós-operatório e submetidos a mensuração de volume corrente, capacidade vital, volume minuto, pressões máximas expiratória e inspiratória, e circunferências abdominal e torácica. Observou-se a ocorrência de complicações pulmonares pós-operatórias e mortalidade. RESULTADOS: No primeiro e terceiro dias de pós-operatório houve queda de 47% e 30,5% na capacidade vital, 18% e 12,5% no volume minuto, 28% e 21% no volume corrente, 47% e 32% no índice diafragmático, 51% e 26% na pressão inspiratória máxima, e 39,5% e 26% na pressão expiratória máxima, respectivamente (p < 0,05). No quinto dia de pós-operatório, todos os valores das variáveis analisadas apresentaram-se maiores que os do primeiro pós-operatório, evidenciando um crescimento linear, com retorno total aos seus valores pré-operatórios apenas de volume corrente, volume minuto e índice diafragmático. Houve uma incidência de complicações pulmonares pós-operatórias de 4,7% e não houve óbitos. CONCLUSÃO: Pacientes submetidos a gastroplastia apresentam redução da função pulmonar, evidenciando um comportamento bastante semelhante ao já observado no pós-operatório de outras cirurgias do andar superior do abdome.
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Abstract
OBJECTIVE Often, the critically ill are not optimized in terms of their chronic diseases and are with little physiologic reserves. DATA SOURCES This article contains a review of the pathophysiology of the major preexisting and chronic pulmonary disease encountered in the critically ill, such as asthma, emphysematous disease, and chronic bronchitis. It also includes a summary of other significant disease processes such as acute respiratory disease syndrome, cigarette smoking, and pulmonary alveolar proteinosis and the implications of obesity and obstructive sleep apnea. When confronted with critical illness, the morbidity is magnified. Close observation of patients for evidence that the underlying disease may complicate their pulmonary status, and vice versa, creates an environment where the whole patient can heal and recover from illness. CONCLUSION The aim of the intensive care unit team should be recognition of the patient at risk, use of necessary therapies (i.e., bronchodilators) as early as feasible, and treatment titrated to realistic endpoints as the acute illness progresses and subsequently resolves.
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Affiliation(s)
- Paul C Tamul
- Section of Critical Care Medicine, Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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El-Solh AA. Clinical approach to the critically ill, morbidly obese patient. Am J Respir Crit Care Med 2004; 169:557-61. [PMID: 14982823 DOI: 10.1164/rccm.200309-1256cc] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ali A El-Solh
- Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, New York, USA.
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Esquide J, Luis RD, Valero C. Anestesia en la cirugía bariátrica. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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