Obesity surgery
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Observational Study
Reliability of Continuous Non-Invasive Assessment of Hemoglobin and Fluid Responsiveness: Impact of Obesity and Abdominal Insufflation Pressures.
During surgery, proper fluid resuscitation and hemostatic control is critical. Pleth variability index (PVI) is advocated as a reliable way of optimizing intraoperative fluid resuscitation. PVI is a measure of dynamic change in perfusion index during a complete respiratory cycle. Non-invasive monitoring of total hemoglobin could provide a reliable means to determine need for transfusion. We analyzed the impact of insufflation and obesity on non-invasive measurements of hemoglobin and PVI in laparoscopic procedures to validate reliability of fluid responsiveness and hemoglobin levels. ⋯ Insufflation or obesity was not associated with significant variations in hemoglobin. Non-invasive monitoring of hemoglobin is useful in laparoscopic procedures in obese and non-obese patients. PVI values should be used cautiously during laparoscopic procedures, particularly in obese patients.
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Randomized Controlled Trial
Preoperative inspiratory muscular training to prevent postoperative hypoxemia in morbidly obese patients undergoing laparoscopic bariatric surgery. A randomized clinical trial.
Morbidly obese patients show an increased risk of postoperative hypoxemia and pulmonary complications when compared with normal weight subjects. The purpose of this study was to determine the effects of preoperative inspiratory muscular training (IMT) on postoperative arterial oxygenation in morbidly obese patients submitted to laparoscopic bariatric surgery. ⋯ Preoperative IMT improved postoperative oxygenation and increased inspiratory muscular strength in morbidly obese patients submitted to laparoscopic bariatric surgery.
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Phase I postanesthesia recovery is often prolonged after laparoscopic bariatric surgery. We hypothesized that postoperative respiratory depression is a major contributor to this delayed recovery. ⋯ Inadequate antiemetic prophylaxis and the treatment of postoperative hypertension were associated with prolonged postanesthesia recovery. Surprisingly, diagnosis of obstructive sleep apnea was not associated with prolonged recovery, which may be attributable to use of continuous positive airway pressure devices following emergence from anesthesia. Prolonged recovery in patients treated for hypertension may be related to institutional guidelines that require additional monitoring time after these medications are administered.
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Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. ⋯ We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.