Obesity surgery
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Case Reports
Lumbar muscle rhabdomyolysis as a cause of acute renal failure after Roux-en-Y gastric bypass.
Rhabdomyolysis occurs when injury to skeletal muscle disrupts the integrity of the sarcolemmal membrane, allowing release of intracellular proteins into the circulation. Serious complications, such as hyperkalemia, hypocalcemia, hyperphosphatemia, compartment syndrome, cardiac dysrhythmias, disseminated intravascular coagulation, and acute renal failure can develop if diagnosis and treatment are delayed. ⋯ Morbidly obese patients are at higher risk for developing postoperative rhabdomyolysis, likely because of increased compressive pressure due to the patient's weight. Surgeons should consider rhabdomyolysis in morbidly obese patients who experience postoperative oliguria. Frequent position changes during operations lasting more than 2 hours can protect muscle tissue from compressive injury.
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Randomized Controlled Trial Clinical Trial
A preliminary study of the optimal anesthesia positioning for the morbidly obese patient.
Hypoxemia during the induction of general anesthesia for the morbidly obese patient is a major concern of anesthesiologists. The etiology of this pathophysiological problem is multifactorial, and patient positioning may be a contributing factor. The present study was designed to identify optimal patient positioning for the induction of general anesthesia that minimizes the risk of hypoxemia in these patients. ⋯ In morbidly obese patients, the 30 degrees Reverse Trendelenburg position provided the longest SAP when compared to the 30 degrees Back Up Fowler and Horizontal-Supine positions. Since on induction of general anesthesia morbidly obese patients may be difficult to mask ventilate and/or intubate, this extra time may preclude adverse sequelae resulting from hypoxemia. Therefore, Reverse Trendelenburg is recommended as the optimal position for induction.
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We have demonstrated that obstructive sleep apnea (OSA) is prevalent in 60% of patients undergoing bariatric surgery. A study was conducted to determine whether weight loss following bariatric surgery ameliorates OSA. ⋯ Weight loss following gastric bypass results in profound improvement in OSA. The severity of apnea cannot be reliably predicted by preoperative BMI and ESS; therefore, patients with symptoms of OSA should undergo polysomnography.
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Metabolic bone disease is a well-documented long-term complication of obesity surgery. It is often undiagnosed, or misdiagnosed, because of lack of physician and patient awareness. Abnormalities in calcium and vitamin D metabolism begin shortly after gastrointestinal bypass operations; however, clinical and biochemical evidence of metabolic bone disease may not be detected until many years later. ⋯ This case illustrates not only the importance of informed consent in patients undergoing obesity operations, but also the importance of adequate follow-up for patients who have undergone these procedures. A thorough history and physical examination, a high index of clinical suspicion, and careful long-term follow-up, with specific laboratory testing, are needed to detect early metabolic bone disease in these patients.