Failed intubation in a patient who had previously undergone jaw fixation

The perioperative management of morbidly obese patients (a surgeon's perspective)

One hundred and thirteen morbidly obese patients underwent bariatric surgery. Mean preoperative percentage above ideal weight was 98.3% (SD 30.0%). Mean percentage above ideal weight eighteen months after operation was 19.5% (SD 23.8%). Fifteen patients (13.3%) required pre-operative weight loss because of respiratory dysfunction and raised PaCO2. One patient developed asthma in the postoperative period. There were no other clinical postoperative respiratory complications. 40% of patients however did show radiological evidence of basal pulmonary atelectasis on the initial postoperative chest X-ray. All patients had pre-operative cardiological screening: there were no cardiac complications except one case of atrial fibrillation. One patient suffered a proven pulmonary embolus and recovered. Six patients (5.3%) required correction of a pre-operative potassium deficit. No episode of gastric acid aspiration syndrome occurred. 58% of patients presenting for obesity surgery had identifiable psychopathology. Despite strict pre-operative psychiatric screening, 15% of patients coming to operation required postoperative psychiatric management.

Jaw wiring in the treatment of morbid obesity

Fourteen patients originally presented with hyperphagia and intractable morbid obesity have had maxillomandibular fixation (MMF) applied in an effort to control their obesity. In 10 patients who were massively obese or considered poor risk candidates for surgical control of their obesity, MMF was applied with the aim of reducing the obesity to a level where a surgical gastric restrictive bariatric procedure could be safely carried out. Eight of these patients had been rejected for surgical control of obesity elsewhere and two were edentulous. Five of these patients after successful weight loss over periods from 16 to 40 weeks (mean percentage overweight lost 84.8, range 39-150) safely underwent a gastric restrictive procedure. All five patients have had continuous weight loss after bariatric surgery. Two patients requested removal of MMF 1 and 2 weeks after application. The remaining three patients, who were candidates for surgery, after successful weight loss over periods from 12 to 28 weeks (mean percentage of overweight lost 45, range 38-50) decided not to proceed with surgical control. All have subsequently regained the lost weight. Four originally morbidly obese patients, who had had a previously successful gastric restrictive procedure followed by weight loss, requested MMF in an effort to lose further weight. Over periods from 8 to 16 weeks three of the four had further weight loss (mean percentage of overweight lost 18.3, range 5-30). After removal of MMF all four patients regained some weight. In only one was there a significant maintenance of weight lost during MMF.(ABSTRACT TRUNCATED AT 250 WORDS)