Best practice & research. Clinical anaesthesiology
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The prevalence of obesity has reached epidemic proportions. Conceptualization of obesity as a chronic disease facilitates greater understanding its treatment. The NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity provides a framework by which to manage the severely obese--specifically providing medical versus surgical recommendations which are based on scientific and outcomes data. ⋯ Surgery is not limited to the procedure itself, it also necessitates thorough preoperative evaluation, risk assessment, and counseling. The most common metabolic surgical procedures include Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion. Surgical outcomes for metabolic surgery are well studied and demonstrate superior long-term weight loss compared to medical management in cases of severe obesity.
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The steady rise in obesity observed in the recent years, coupled with its associated co-morbidities, suggests that clinicians will encounter obese patients with increasing frequency in their daily practice. Unfortunately, obese subjects are often excluded from clinical trials during the drug development process. ⋯ This review provides a pragmatic approach to the pharmacokinetic considerations that should guide drug administration. We hereby offer a systematic approach to dosing scalars, followed by an analysis of the factors affecting pharmacokinetics in obesity, and provide a detailed discussion on the single most commonly used pharmacological agents in anaesthesia.
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The incidence of childhood obesity ranges today from approximately 8% to 17%, and is an increasing issue in developed and developing countries. This disease will become increasingly significant in paediatric anaesthesia. ⋯ This review covers current definition and some epidemiology of childhood obesity. It summarises potential co-morbidities and provides details for preoperative evaluation, anaesthetic management and prevention of perioperative complications.
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Best Pract Res Clin Anaesthesiol · Mar 2011
ReviewRegional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance.
Obesity is associated with a number of anaesthetic-related risks. Regional anaesthesia offers many potential advantages for the obese surgical patient. ⋯ Ultrasound guidance may aid the regional anaesthesia practitioner with direct visualisation of underlying anatomic structures and real-time needle direction. Further research is needed to determine optimal regional anaesthesia techniques, local anaesthetic dosage and perioperative outcomes in obese patients.