Obesity surgery
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Obstructive sleep apnea syndrome (OSAS) is present in 44% of patients scheduled for bariatric surgery. Respiratory dysfunction associated with this syndrome is attributable to chronic obstructive pulmonary disease (COPD) and/or obesity hypoventilation syndrome (OHS). We studied the long-term effect of bariatric surgery on weight loss, on the respiratory comorbidities associated with obesity, and on the need for non-invasive positive pressure ventilation. ⋯ Weight loss after RYGBP improved arterial blood gases, respiratory tests and polysomnographic studies. CPAP treatment can be withdrawn in most patients.
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Comparative Study
Cholecystectomy during laparoscopic gastric bypass has no effect on duration of hospital stay.
Laparoscopic cholecystectomy can be safely performed at the time of laparoscopic Roux-en-Y gastric bypass (LRYGBP). This study was primarily conducted to examine whether there is any difference in the length of hospital stay and duration of operation in patients who undergo concomitant cholecystectomy with their LRYGBP. In addition, the frequency and nature of complications in the two groups were compared. ⋯ Laparoscopic cholecystectomy performed at the time of LRYGBP does not alter length of hospital stay or frequency of postoperative complications and only adds an extra half hour to total operation time.
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Randomized Controlled Trial
Treatment with lavender aromatherapy in the post-anesthesia care unit reduces opioid requirements of morbidly obese patients undergoing laparoscopic adjustable gastric banding.
Parenteral administration of opioids and NSAIDs has been the mainstay for postoperative pain control in patients undergoing laparoscopic adjustable gastric banding (LAGB). Both classes of drugs, however, are associated with serious adverse effects. An addition of complimentary analgesic techniques may decrease requirement for traditional analgesics, thus reducing the incidence of side-effects. We designed the study to evaluate the effectiveness of Lavender aromatherapy in reducing opioid requirements after LAGB. ⋯ Our results suggest that lavender aromatherapy can be used to reduce the demand for opioids in the immediate postoperative period. Further studies are required to assess the effect of this therapy on clinically meaningful outcomes, such as the incidence of respiratory complications, delayed gastric emptying, length of hospital stay, or whether this therapy is applicable to other operations.
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Obesity is the most important risk factor for obstructive sleep apnea. It is estimated that 70% of sleep apnea patients are obese. In the morbidly obese, the prevalence may reach 80% in men and 50% in women. The aim of this study was to determine the prevalence and severity of sleep apnea in a group of morbidly obese patients, leading to bariatric surgery. ⋯ There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request polysomnography, thus enabling therapeutic management and prognostication.
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Randomized Controlled Trial
A randomized trial of bupivicaine pain pumps to eliminate the need for patient controlled analgesia pumps in primary laparoscopic Roux-en-Y gastric bypass.
The use of a bupivicaine pain pump has previously been reported to lower costs to hospitals, while providing similar pain relief to opioid-based patient controlled analgesia (PCA) pumps. However, these benefits have not been investigated in laparoscopic bariatric surgery. ⋯ The use of a bupivicaine pain pump offers the opportunity to dramatically reduce the use of opioids postoperatively in all bariatric patients by eliminating PCA. This change could potentially reduce the incidence of respiratory failure from oversedation, while offering the same levels of pain control.