Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Sep 2012
Comparative StudyCarbon dioxide elimination pattern in morbidly obese patients undergoing laparoscopic surgery.
Hypercapnia can result from carbon dioxide pneumoperitoneum and adversely affect the postoperative period, particularly in morbidly obese patients. The purpose of the present study was to examine carbon dioxide homeostasis using a metabolic monitor in morbidly obese and normal weight patients during laparoscopic surgical procedures. The setting was a university hospital in Italy. ⋯ The results of our study have shown that the load of carbon dioxide insufflated is well tolerated in morbidly obese patients, as well as in normal patients, with proper intraoperative ventilation adjustments. However, after pneumoperitoneum, the return to a normal total exhaled carbon dioxide per minute required a longer period in the morbidly obese group. Prolonged mechanical ventilation is therefore advisable in morbidly obese patients.
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Surg Obes Relat Dis · Sep 2012
Distal airway dysfunction in obese subjects corrects after bariatric surgery.
Obesity is frequently associated with respiratory symptoms despite normal large airway function as assessed by spirometry. However, reduced functional residual capacity and expiratory reserve volume are common and might reflect distal airway dysfunction. Impulse oscillometry (IOS) might identify distal airway abnormalities not detected using routine spirometry screening. Our objective was to test the hypothesis that excess body weight will result in distal airway dysfunction detected by IOS that reverses after bariatric surgery. The setting was a university hospital. ⋯ The present study detected significant distal airway dysfunction despite normal preoperative spirometry findings. The effect of increased body weight was likely the main mechanism for these abnormalities. However, the inflammatory state of obesity or associated respiratory disease could also be invoked. These abnormalities improved significantly toward normal after weight loss. The results of the present study highlight the importance of bariatric surgery as an effective intervention in reversing these respiratory abnormalities.
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Although 85% of the American public believes that obesity is an "epidemic," great controversy exists what role the government, public policy, and law should play in addressing the problem. This keynote address discusses the philosophical and economic justifications for treating obesity as a public health problem meriting government intervention and explores the possible legal and policy solutions.