Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Nov 2008
Use of critical care resources after laparoscopic gastric bypass: effect on respiratory complications.
Before 2005, all subjects undergoing laparoscopic gastric bypass with a body mass index >50 kg/m(2), age >40 years, and documented obstructive sleep apnea (OSA) were admitted to the intensive care unit (ICU) in our institution. Starting in January 2005, only patients with a body mass index >60 kg/m(2) and severe OSA were admitted. This study assessed the incidence of respiratory complications in patients undergoing laparoscopic gastric bypass before and after implementation of the new ICU admission criteria. ⋯ Limiting ICU admission after laparoscopic gastric bypass to patients with a body mass index >60 kg/m(2) and severe OSA did not increase the overall incidence of postoperative respiratory complications or hospital stay.
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Surg Obes Relat Dis · Nov 2008
Limitations of a standardized weight-based nomogram for heparin dosing in patients with morbid obesity.
Confusion exists when dosing heparin using a weight-based nomogram in the obese population. At 2 affiliated community teaching hospitals, we compared the activated partial thromboplastin time (aPTT) values in morbidly obese and nonmorbidly obese patients using a standardized nomogram and determined factors associated with achieving a supratherapeutic aPTT value. ⋯ Heparin dosing with a weight-based nomogram will yield greater aPTT values in morbidly obese patients. Consideration of BMI and age can help identify those patients at risk of supratherapeutic aPTTs. Alternative strategies, such as a dose cap should be considered in patients with morbid obesity.