Obesity surgery
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Comment Comparative Study
Is heated and humidified gas necessary during laparoscopic gastric bypass?
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Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients. We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. ⋯ No desaturation episodes were recorded. Pain was managed with I. V. drip of ketorolac and tramadole.
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Randomized Controlled Trial Clinical Trial
Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions.
The effect of patient position on the view obtained during laryngoscopy was investigated. ⋯ The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.
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Associated or rare diseases, such as myasthenia gravis, introduce a challenge to the perioperative management of severely obese patients undergoing bariatric surgery. We report the surgical management and unique anesthetic approach to a 55-year-old morbidly obese woman with a complex past medical history that included myasthenia gravis, who underwent laparoscopic gastric bypass. ⋯ Continued perioperative anticholinesterase administration may have facilitated this successful outcome. We conclude that a diagnosis of myasthenia gravis does not mandate postoperative mechanical ventilation following laparoscopic gastric bypass.
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The number of weight reduction operations performed for type II and type III obesity is rapidly escalating. Risk of surgery has been infrequently stratified for patient subgroups. The purpose of this study was to identify patient characteristics that increased the odds of a prolonged hospital length of stay (LOS) following open or laparoscopic Roux-en-Y gastric bypass (RYGBP). ⋯ Open surgery, BMI, length of surgery,sleep apnea, asthma and hypercholesterolemia all increased the odds of a prolonged LOS. Patients with the greatest odds of long LOS were women with asthma or coronary disease, men with sleep apnea or the metabolic syndrome, and patients undergoing laparoscopic surgery with sleep apnea or coronary artery disease. Patients at high-risk for prolonged hospital stay can be identified before undergoingRYGBP. Surgeons may wish to avoid high-risk patients early in their bariatric surgery experience.