Perioperative management of the severely obese patient: a selective pathophysiological review (original) (raw)
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Peri-operative and critical care management of morbidly obese patients
Sohag Medical Journal, 2019
AIM: The aim of this work is to know the pathophysiological mechanism of critically ill obese patients and to recognize the new requirements for their management in the critical-care-setting. The obese patient's category is still increasing in many westernized countries especially the united states (USA). As a result, the peri-operative management of obese patients became routine care. As obese patients are now liable for all types of procedures, it is essential and very important for all anesthesiologists, surgeons, perioperative-health care providers to understand their different multi-organ physiology so as to safely prepare those obese patients perioperatively. A good assessment of those patients pre-operatively can decrease the risk of postoperative complications later on …, in this manuscript, we mention the major considerations for the preoperative assessment of morbidly obese patients. Obesity now became the main cause of increased morbidity and mortality because of acute and chronic medical diseases, like diabetes mellitus, hypertension, cardiovascular problems, renal disorders, arthritis, and certain types of cancer (Mokdad et al. 2003). Obese patients, particularly morbidly ones, have a higher percentage of resource utilization, intensive care unit entrance, respiratory diseases, and respiratory distress syndrome, than do nonobese patients (Westerly and Dabbagh2011). also, obese patients are at higher danger for postoperative complications
Critical care of the obese and bariatric surgical patient
Critical Care Clinics, 2003
Obesity is a major health problem worldwide and has reached epidemic proportions in the western society. Obesity (Latin for overeat) is defined as an abnormally high percentage of body weight as fat. The World Health Organization and the National Institute of Health have endorsed the body mass index [BMI = weight (kg) / height (m 2 )] as a measure of obesity because of its strong correlation with adiposity. Obesity is defined as a BMI of 30 or higher, morbid or severe obesity is defined as a BMI of 40 or higher, and superobesity is defined as a BMI in excess of 50.
Obesity surgery, 2018
Obesity is a worldwide disease related to genetic, environmental, and behavioral factors, and it is associated with high rates of morbidity and mortality. Recently, obesity has been characterized by a low-grade inflammatory state known as inflammome indicated by chronic increases in circulating concentrations of inflammatory markers. The purpose of this study was to evaluate the effect of weight loss induced by surgery for obesity and weight-related diseases on pro-inflammatory cytokine (TNF-α) and anti-inflammatory adipokine (adiponectin) levels, and on an adipose-derived hormone (leptin) in severely obese subjects. This randomized, controlled trial involved 55 severe obese patients (50 women, age 18-63 years, and body mass index of 35.7-63 kg/m) who underwent bariatric surgery (BS). Patients with a BMI > 65 kg/mand clinical and mental instability, or significant and unrealistic expectations of surgery were excluded. Blood samples were collected during the fasting period to anal...
Obesity Decreases Perioperative Tissue Oxygenation
Anesthesiology, 2004
Background: Obesity is an important risk factor for surgical site infections. The incidence of surgical wound infections is directly related to tissue perfusion and oxygenation. Fat tissue mass expands without a concomitant increase in blood flow per cell, which might result in a relative hypoperfusion with decreased tissue oxygenation. Consequently, we tested the hypotheses that perioperative tissue oxygen tension is reduced in obese surgical patients. Furthermore, we compared the effect of supplemental oxygen administration on tissue oxygenation in obese and non-obese patients.
Emergencies in obese patients: a narrative review
Journal of Anesthesia, Analgesia and Critical Care, 2021
Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID...
Anesthesia for Morbidly Obese Patients
World Journal of Surgery, 1998
Bariatric surgery is the most effective method for treating patients with morbid obesity, and participation of the anesthesiologist in the treatment of these patients is more and more frequent. Therefore it is important for anesthesiologists to be familiar with anatomic and physiologic implications and the pharmacologic changes associated with obesity, so they can offer optimal perioperative treatment. The present study describes a series of 37 patients with an average body mass index of 50.3 kg/m 2 who underwent bariatric surgery in a third-level teaching hospital in Mexico City. Preoperative assessment, airway management, perioperative treatment, and the incidence of complications are analyzed. We found a high frequency of associated diseases, among which diabetes mellitus and systemic arterial hypertension were the most prominent. Cardiorespiratory complications such as obstructive sleep apnea syndrome and obesity-hypoventilation syndrome were particularly frequent (16.2% and 22.0%, respectively). Both general anesthesia and mixed anesthesia (peridural block plus light general anesthesia) were employed. The incidence of complications related to perioperative and anesthetic management was low. We discuss and propose protocols for the evaluation and management of airway and associated cardiorespiratory complications.
Cardiovascular Evaluation and Management of Severely Obese Patients Undergoing Surgery
Circulation, 2009
Obesity is associated with comorbidities that may lead to disability and death. During the past 20 years, the number of individuals with a body mass index >30, 40, and 50 kg/m 2 , respectively, has doubled, quadrupled, and quintupled in the United States. The risk of developing comorbid conditions rises with increasing body mass index. Possible cardiac symptoms such as exertional dyspnea and lower-extremity edema occur commonly and are nonspecific in obesity. The physical examination and electrocardiogram often underestimate cardiac dysfunction in obese patients. The risk of an adverse perioperative cardiac event in obese patients is related to the nature and severity of their underlying heart disease, associated comorbidities, and the type of surgery. Severe obesity has not been associated with increased mortality in patients undergoing cardiac surgery but has been associated with an increased length of hospital stay and with a greater likelihood of renal failure and prolonged a...
Context: Perioperative management of morbidly obese patients undergoing bariatric surgery is challenging. Lacking standardized perioperative protocols, complication rates may be high. This retrospective study aims to quantify the incidence of signifi cant blood pressure decreases on induction of anesthesia and intraoperative hypoxemia, before implementation of a standardized protocol designed for bariatric surgery. Design: Retrospective, observational study. Setting: A 250-bed county hospital in northern Sweden. Subjects: 219 morbidly obese patients (body mass index > 35 kg/m2) who underwent bariatric surgery between 2003 and 2008. Main outcome measures: Incidence of systolic blood pressure (SAP) falls to less than 70% of the preoperative baseline during induction of anesthesia and incidence of perioperative hypoxemia. Results: The incidence of confi rmed SAP falls to below 70% of baseline at induction of anesthesia was 56.2% (n = 123/219). This incidence rose with increasing age...
Medicinski Glasnik Specijalne Bolnice za Bolesti Štitaste Žlezde i Bolesti Metabolizma Zlatibor, 2017
Introduction: Morbid obesity is associated with a number of ventilatory and cardiovascular disorders and increased risk for cardiovascular diseases, which can be improved by weight loss. Cardiopulmonary testing (CPET) is proposed for the objective evaluation of the effects of bariatric surgery in morbid obese patients. Aim: To evaluate the change of CPET and hemodynamic parameters in patients treated with bariatric surgery. Methods: We performed CPET in 250 morbid obese patients during for the preoperative assessment. We analyzed 50 patients (37 women, mean age 38±10 years) before and 6 months after bariatric surgery. All patients underwent CPET (treadmill, Bruce protocol) with expiratory gas analyses. Results: The mean weight before treatment was 126.69 ±19.21kg, and BMI was 43.8 ± 5.4 kg/m 2. Averaged body weight reduction was-29, 6 kg, and BMI-10 kg/m2 after 6 months follow-up, with significant difference in comparison to baseline values (43.8±5, 4 vs 33.9±14, 3; p<0.0001). CPET parameters showed increase in VO2 at ventilatory anaerobic threshold (17.86±3.44 vs 20.86±4.70; p<0.0001), Peak VO2 (20.79±3.63 vs 24.97±4.37; p<0.0001) and improvement of ventilatory efficacy VE/VCO2 slope (34.64±4.34 vs 24.74±3.39; p<0.0001), and PetCO 2 confirming the improvement of cardiopulmo