Obesity surgery
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Bariatric surgery at the upper extremes of weight can be associated with serious postoperative complications. In many cases, these complications will require the availability of critical care resources. The purpose of this study is to examine factors that increase the likelihood for prolonged postoperative intensive care unit (ICU) and extended mechanical ventilation (MV) >24 hours. ⋯ Patients who are male, older (>50 yrs), heavier (BMI >60 kg/m2), and who have complications requiring reoperation will likely need intensive care. Additionally, males, heavier patients (BMI >60 kg/m2), pulmonary co-morbidity, and need for reoperation may warrant need for extended MV. Surgeons and hospitals should consider this when planning resources for bariatric surgery programs.
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We evaluated the impact of surgically-induced weight loss on Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), electrocardiographic changes, pulmonary arterial pressure and daytime sleepiness in morbidly obese patients. ⋯ Bariatric surgery effectively reduces respiratory disturbances during sleep and improves pulmonary hypertension. Electro cardiographic abnormalities change after surgery. Daytime sleepiness appeared not to be related to respiratory disturbances during sleep.
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The use of low molecular weight heparin (LMWH) is increasing throughout North America and Europe for a number of reasons: 1). ease of use; 2). predictable dose response; 3). less heparin associated thrombocytopenia. However, aside from increased costs, LMWH has significant potential drawbacks: 1). poor reversibility; 2). tendency to accumulate in renal insufficiency; 3). less experience in subset patient groups such as morbid obesity. We report a case of a postoperative morbidly obese patient who developed enoxaparin toxicity secondary to acute renal failure that did not reverse with protamine sulfate infusion. In addition, we review the use of LMWH in renal insufficiency, dosing in obese patients,and the importance of sulfate content in the efficacy of protamine sulfate as a reversing agent for LMWH.
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Randomized Controlled Trial Comparative Study Clinical Trial
Post-anesthesia recovery after infusion of propofol with remifentanil or alfentanil or fentanyl in morbidly obese patients.
The type of opioid used during general anesthesia in the morbidly obese influences recovery and the postoperative period. In a randomized clinical trial, the postoperative recovery profile and early period after general anesthesia with remifentanil, fentanyl and alfentanil were compared in morbidly obese patients. ⋯ In morbidly obese individuals, alfentanil or fentanyl and remifentanil can be safely used, but there is a higher rate of PONV and postoperative pain in the remifentanil group.