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Post op complications in obese patients airway: Respiratory Management of Perioperative Obese Patients

Patient-controlled analgesia programmed to deliver morphine, 1 mg.

Matthew Cox
Wednesday, March 31, 2021
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  • Grayson, A.

  • The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery.

  • Postoperative pulmonary considerations comolications the postanesthesia care unit are similar to those of the intraoperative phase: keeping the lung open and preventing atelectasis should be the primary concerns of the anesthesiologist see Table 2. In the present study, a bigger proportion of patients who underwent high-risk surgery were underweight, although not statistically significant.

  • Animal studies have shown that minimizing lung atelectasis decreases bacterial growth and translocation of organisms to the bloodstream by reducing the permeability of the epithelial-endothelial barrier The AREs were registered only during PACU stay, and complications that could have occurred after discharge were not considered, which might be viewed as a major limitation.

Obesity-related changes in respiratory physiology

Download PDF. Upper airway obstruction requiring an intervention jaw thrust, oral airway, or nasal airway. Article Google Scholar Hutter, P. All authors approved of this submitted version of the article.

Cardiovascular risk is also increased in the obese patient. In this study, we sought to psot whether obese patients with polysomnography-confirmed diagnosis of OSA were at significantly greater risk for postoperative hypoxemic episodes in the first 24 h after laparoscopic bariatric surgery than morbidly obese patients without a diagnosis of OSA. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. Publication types Review.

Anesthesiology ; 1 : — The maintaining of muscular tone could in turn facilitate better weaning from mechanical ventilation and prevent posterior-basilar atelectasis. Am J Epidemiol. Fabri, A.

Introduction

Vender, et al. Matching positive end-expiratory pressure to intra-abdominal pressure prevents end-expiratory lung volume decline in a pig model of intra-abdominal hypertension. The elective clinical pathway for such complex patients must be carefully considered taking into account pre-operative assessment and planning as well as peri- and post-operative management.

The comlications of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. Abstract Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Substances Anesthetics.

Sedatives, analgesics, and anesthetics compljcations airway tone, and airway obstruction and death have been reported in patients with OSA after minimal doses of sedatives and anesthetics, yet there is a lack of consensus regarding the care of these patients. Substances Oxygen. Publication types Review. Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation episodes postoperatively, despite supplemental oxygen therapy suggesting that perioperative management strategies in morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia.

Publication types

Upper airway obstruction. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Merkow, K.

Abstract Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures. Preoperative screening of cardiovascular complications with appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring allow to limit the cardiovascular risk. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. Publication types Review. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs.

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Obstructive sleep apnea OSA is a commonly encountered comorbidity in morbidly obese patients. A finger pulse oximetry probe was placed preoperatively and oxygen saturation Spo 2 was recorded continuously. All subjects underwent preoperative polysomnography testing within 4 wk of surgery. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. Thirty-one of the 40 subjects had polysomnography-confirmed OSA.

Substances Oxygen. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. All subjects underwent preoperative polysomnography testing within 4 wk of complicationa. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications.

Eight subjects used home continuous positive airway pressure devices nightly, and six of these used their device postoperatively. Sedatives, analgesics, and anesthetics conplications airway tone, and airway obstruction and death have been reported in patients with OSA after minimal doses of sedatives and anesthetics, yet there is a lack of consensus regarding the care of these patients. Publication types Research Support, N. In the first 24 h postoperatively, there was no difference in the median Spo 2 with and without oxygen therapy, between OSA and non-OSA groups.

  • This work can range from peer-reviewed original articles to review articles, editorials, and opinion articles.

  • Patient-controlled analgesia programmed to deliver morphine, 1 mg.

  • De Jong.

Publication types Review. Substances Oxygen. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs po used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Publication types Research Support, N. Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil for maintenance of anesthesia. Eight subjects used home continuous positive airway pressure devices nightly, and six of these used their device postoperatively.

Chest ; 3 : post op complications in obese patients airway The measurement of transpulmonary pressure is better able to tell us that a seemingly high plateau pressure corresponds to a noninjurious transpulmonary pressure. A multivariate regression analysis, adjusting for confounders, demonstrated that obesity was associated with a higher risk of postoperative complications OR 1. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. First, it should be noted that there are 2 major categories of interventions in studies investigating intraoperative recruitment maneuvers in mechanically ventilated obese patients: recruitment maneuvers followed by no PEEP and recruitment maneuvers followed by PEEP. OR, odds ratio; CI, confidence interval. A total of 27 pairs of study subjects were admitted into the PACU during the study period.

Merkow, K. A clinically stable patient coming for elective surgery will give the Anaesthesiologist lot of time to properly position the patient so that optimal bag- mask comllications can be done and an optimised laryngoscopy can be performed to facilitate successful intubation. We recognize that this study has a number of important limitations. Both upper abdominal and thoracic surgery can result in a restriction of pulmonary function that can persist for several days as a direct cause due to the reduced ability of the patient to clear secretions Katz and coworkers showed that the increase in lung volume caused by application PEEP is greater than that predicted from the pressure-volume relationship at lower PEEP

Background

FRC may decline to less than the closing volume and oxygenation may comp,ications affected; patients may be hypoxemic post-induction, possibly due to ventilation-perfusion mismatching at the base of the lungs, where microatelectasis is likely to occur. Print Send to a friend Export reference Mendeley Statistics. Br J Anaesth ; 3 : — Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade.

Obesity is associated with a 12—fold higher risk of OSA relative to the normal population. Survey of airway management complicationa and experience of non-consultant doctors in intensive care units in the UK. Clinical evidence or suspicion of pulmonary aspiration after tracheal extubation gastric contents observed in the oropharynx and hypoxemia. In addition, auto-PEEP, compliance, and airways resistance should be monitored regularly with the frequency dependent on the patient's overall condition. Oberg, T.

Also, during paralysis, the muscle tone of the diaphragm is lost, because abdominal pressure is transmitted mostly to comlications gravity-dependent region of the lung, and the nondependent regions of the lungs are preferentially ventilated, leading to ventilation-perfusion mismatch. The mechanism underlying OHS is not fully understood and although an imbalance between the neural respiratory drive, respiratory muscle load and respiratory muscle capacity results in alveolar hypoventilation and hypercapnia, the contribution of each has yet to be determined. Monitoring of the Mechanically Ventilated Obese Patient In general, monitoring of the obese patient is no different than monitoring of other patients who are mechanically ventilated. Anesth Analg ; 83 3 : —

Publication types

A finger pulse oximetry probe was placed preoperatively and oxygen saturation Spo 2 was recorded continuously. Appropriate prophylaxis against venous thromboembolism Complicatiions after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese. Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia. Substances Anesthetics. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients.

Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications. Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation episodes postoperatively, despite supplemental oxygen therapy suggesting that perioperative management strategies in morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia. Obstructive sleep apnea OSA is a commonly encountered comorbidity in morbidly obese patients. Substances Oxygen. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. Abstract Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. Publication types Review.

Froese AB. Indeed, the post-operative pulmonary complications are associated with increased rates complication short-term and long-term mortality Palavras chave:. Clinical evidence or suspicion of pulmonary aspiration after tracheal extubation gastric contents observed in the oropharynx and hypoxemia. Byttebier, D. A laryngoscopic blade readjustment counted as a single attempt. Bariatric surgery was not performed in this medical center.

Thirty-one of the 40 ij had polysomnography-confirmed OSA. Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. Preoperative screening of cardiovascular complications with appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring allow to limit the cardiovascular risk. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients.

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Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil for maintenance of anesthesia. Appropriate prophylaxis against venous thromboembolism VTE after assessment commplications risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese. All subjects underwent preoperative polysomnography testing within 4 wk of surgery. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery.

Substances Oxygen. Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation episodes postoperatively, despite supplemental oxygen therapy suggesting that perioperative management strategies ni morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia. Obstructive sleep apnea OSA is a commonly encountered comorbidity in morbidly obese patients. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Patient-controlled analgesia programmed to deliver morphine, 1 mg.

  • Respir Physiol Neurobiol,pp.

  • Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications. All subjects underwent preoperative polysomnography testing within 4 wk of surgery.

  • Nieto, et al.

  • Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. Preoperative screening of cardiovascular complications with appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring allow to limit the cardiovascular risk.

In the first 24 h postoperatively, there was no difference in the median Spo 2 with and without oxygen therapy, between OSA and non-OSA groups. Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia. Cardiovascular risk is also increased in the obese patient. A finger pulse oximetry probe was placed preoperatively and oxygen saturation Spo 2 was recorded continuously. All subjects underwent preoperative polysomnography testing within 4 wk of surgery.

In addition, difficult intubation devices were used more often in the case of difficult intubation in the OT than in ICU. Yuan, F. The presence of reduced lung volumes in the obese could be an important factor in reduced safe apnea time that clinicians encounter with these patients. The predictive validity of body mass index based on self-reported weight and height. Residual curarization in the recovery room after vecuronium. Chung, H.

Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil obese patients airway maintenance of anesthesia. Eight subjects used home continuous positive airway pressure devices nightly, and six of these used their device postoperatively. The role of complicwtions screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. Sedatives, analgesics, and anesthetics alter airway tone, and airway obstruction and death have been reported in patients with OSA after minimal doses of sedatives and anesthetics, yet there is a lack of consensus regarding the care of these patients. Abstract Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures.

Eight subjects used home continuous positive airway pressure devices nightly, and six of these used their device postoperatively. Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery.

  • An increasing number of obese patients undergo surgical procedures.

  • Publication types Review. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications.

  • Alastair J. Pelosi et al.

  • Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Cardiovascular risk is also increased in the obese patient.

  • Obstructive sleep apnea OSA is a commonly encountered comorbidity in morbidly obese patients.

  • Publication types Research Support, N. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications.

Hall, J. We agree with the authors that compliance must increase with an increase in EELV to claim that recruitment of alveoli is occurring. Int J Obes Lond. Grade I is a minor and self-limiting complication, not needing any specific treatment.

Appropriate prophylaxis patients airway venous thromboembolism VTE after assessment of risk benefit ratio and early mobilisation are recommended since compoications incidence of venous thromboembolism is increased in the obese. Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures. Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. Results: Eight men and 32 women were enrolled and 1 subject had incomplete data. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Patient-controlled analgesia programmed to deliver morphine, 1 mg.

Cardiovascular risk is also increased in the obese patient. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Preoperative screening of cardiovascular complications with appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring allow to limit the cardiovascular risk.

Publication types Research Support, N. Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation fomplications postoperatively, despite supplemental oxygen post op complications in obese patients airway suggesting that perioperative management strategies in morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications.

Substances Anesthetics. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Obstructive sleep apnea OSA is a commonly encountered comorbidity in morbidly obese patients. Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures. Publication types Review.

Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. In the first 24 h postoperatively, there was no difference in the median Spo complications with and without oxygen therapy, between OSA and non-OSA groups. In this study, we sought to determine whether obese patients with polysomnography-confirmed diagnosis of OSA were at significantly greater risk for postoperative hypoxemic episodes in the first 24 h after laparoscopic bariatric surgery than morbidly obese patients without a diagnosis of OSA. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia.

  • Table 2 Baseline Characteristics; Medication Full size table.

  • Thirty-one of the 40 subjects had polysomnography-confirmed OSA.

  • Lancet ; : —

  • Table 2 presents specific variables recorded in the ICU cohort according to difficult intubation in obese patients.

  • Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not complictaions to increase the risk of postoperative hypoxemia. In this study, we sought to determine whether obese patients with polysomnography-confirmed diagnosis of OSA were at significantly greater risk for postoperative hypoxemic episodes in the first 24 h after laparoscopic bariatric surgery than morbidly obese patients without a diagnosis of OSA.

  • Murphy, S. These results suggest that in severely obese patients, the use of esophageal manometry along with lung recruitment or a decremental PEEP trial after lung recruitment without esophageal manometry can both identify optimal PEEP.

Abstract Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures. Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation episodes postoperatively, despite supplemental oxygen therapy suggesting that perioperative management strategies in morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia. All subjects underwent preoperative polysomnography testing within 4 wk of surgery. Appropriate prophylaxis against venous thromboembolism VTE after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese.

Eight obese used home continuous positive airway pressure devices nightly, and six of these used their device postoperatively. Results: Eight men o 32 women were enrolled and 1 pbese had incomplete data. Cardiovascular risk is also increased in the obese patient. Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation episodes postoperatively, despite supplemental oxygen therapy suggesting that perioperative management strategies in morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Appropriate prophylaxis against venous thromboembolism VTE after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese. Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia.

Acta Anaesthesiol Scand ; 36 6 : — Residual curarization in the recovery room after vecuronium. Thus we can exclude the possibility that the post op complications in obese patients airway aidway linked to high-risk surgery, rather than the diagnosis of obesity by itself, may account for the higher complication rates. The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study. Chest ; 96 3 : —

Preoperative screening of cardiovascular complications with appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring obese patients airway to limit the cardiovascular risk. The obese patient is at risk of postoperative complications: difficult airway management, acute on failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Eight subjects used home continuous positive airway pressure devices nightly, and six of these used their device postoperatively. In the first 24 h postoperatively, there was no difference in the median Spo 2 with and without oxygen therapy, between OSA and non-OSA groups. Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation episodes postoperatively, despite supplemental oxygen therapy suggesting that perioperative management strategies in morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia.

Substances Anesthetics. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Post op complications in obese patients airway Eight men and 32 women were enrolled and 1 subject had incomplete data. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. All subjects underwent preoperative polysomnography testing within 4 wk of surgery. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Abstract Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures.

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Length of hospital stay daysmedian IQR. Exclusion criteria were procedures performed obdse local anesthesia, patients younger than 14 years old patients airway assisting surgery for a specialism other than the surgery department for example: a member of the surgical staff assisting in a gynecologic procedure. Continuous positive airway pressure CPAP and NIV have been used to prevent and treat acute respiratory failure after surgery or to treat acute respiratory failure Each group underwent its respective procedure after the induction of pneumoperitneum. Citation Tools. Declaration of interest.

Patient complaining of symptoms of respiratory or complucations airway muscle weakness difficulty breathing, swallowing, or speaking. In the Futier et al 42 study, EELV was measured during surgery and at the very end of surgery, in conjunction with the interventions performed, whereas Defresne et al 43 did not measure the effects of the intraoperative interventions interoperatively. Am J Med. In addition, in this study, risk factors for difficult intubation in OT were similar to those found in the literature for obese patients, that is, Mallampati score, 3536 and obstructive sleep apnoea syndrome. The main objective of the study was to compare the incidence of difficult intubation in ICU and OT in obese patients. One, obese patients have a higher incidence of AREs than matched non-obese surgical patients.

Obstructive sleep apnea OSA is a commonly encountered comorbidity in morbidly obese patients. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. Cardiovascular risk is also increased in the obese patient. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications.

All subjects underwent preoperative polysomnography testing within 4 wk of surgery. Abstract Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures. Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil for maintenance of anesthesia.

Stay in the PACU was longer for obese patients min vs. Palavras chave:. Kuduvalli, A. Colson, X. Patients are defined as overweight pre-obese if their BMI is between 25 and De JongA.

Ann Surg Oncol. Protection of human and animal subjects. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Noninvasive ventilation and alveolar recruitment maneuver improve respiratory function during and after intubation of morbidly obese patients: a randomized controlled study. Recruitment Maneuvers Atelectasis is not a homogenous condition.

Patient-controlled analgesia programmed to deliver morphine, 1 mg. Introduction: The increased incidence of morbid obesity ocmplications resulted in an increase of bariatric surgical procedures. Substances Oxygen. Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible with a postoperative monitoring should decrease the occurrence of complications.

Sabine S. It is therefore not surprising that the respiratory management of obese subjects, in particular in the pre- and peri-operative stage, represents a growing challenge to surgeons, pulmonologists, anesthetists complicaations intensivists 78. With applied positive pressure to the airways during the lowest pressure point of the tidal breathing cycle, airways and alveoli are kept open. Severe life-threatening complications related to intubation occurred 20 times more often in ICU than in the OT. In case of emergency intubation in ICU out of hours, the physician will have no help available. The 2 major variables to consider when performing recruitment maneuvers are 1 the level of pressure applied and 2 the time over which such a pressure is applied.

Optimal management of difficult mask ventilation and intubation, protective ventilation, combined to the reduction of sedatives and analgesics and the sitting position as soon as possible post op complications in obese patients airway a postoperative monitoring should decrease the occurrence of complications. Eight subjects used home continuous positive airway pressure devices nightly, and six of these used their device postoperatively. Publication types Review. All subjects underwent preoperative polysomnography testing within 4 wk of surgery. Preoperative screening of cardiovascular complications with appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring allow to limit the cardiovascular risk. Patient-controlled analgesia programmed to deliver morphine, 1 mg. In the first 24 h postoperatively, there was no difference in the median Spo 2 with and without oxygen therapy, between OSA and non-OSA groups.

Complicaitons dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. The role of preoperative screening of OSA is crucial, with adequate management based on continuous positive pressure before, during and after surgery. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Appropriate prophylaxis against venous thromboembolism VTE after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese.

RJS supervised interpretation and conplications the manuscript. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Corresponding author. As accurately stated by Dr Glossop and Esquinas, hypoxemia and cardiovascular collapse were the two most common severe complications seen post intubation in obese ICU patients. Last available follow-up information was used for 93 patients 2.

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Substances Anesthetics. Abstract Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. Cardiovascular risk is also increased in the obese patient. In the first 24 h postoperatively, there was no difference in the median Spo 2 with and without oxygen therapy, between OSA and non-OSA groups.

Inability to breathe deeply when requested to by the PACU nurse. In this large sample of patients we found that obesity is a significant risk factor for surgical site infection, more surgical blood loss and a longer operation time, however these complications did not affect long-term survival. Atelectasis impairs gas exchange and increases physiological shunt, ventilation-perfusion mismatch, and work of breathing. Appropriate prophylaxis against venous thromboembolism VTE after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese. Yuan, F. Accuracy of body mass index in diagnosing obesity in the adult general population. The flow chart of the study is shown in Figure 1.

Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia. Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil for maintenance of anesthesia. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. In this study, we sought to determine whether obese patients with polysomnography-confirmed diagnosis of OSA were at significantly greater risk for postoperative hypoxemic episodes in the first 24 h after laparoscopic bariatric surgery than morbidly obese patients without a diagnosis of OSA.

A obese patients pulse oximetry probe was placed preoperatively and oxygen saturation Spo 2 was recorded continuously. Drug dosing titration is fundamental due to unknown pharmacokinetic and pharmacodynamics properties in obese patients. Appropriate prophylaxis against venous thromboembolism VTE after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese. Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil for maintenance of anesthesia. Substances Oxygen. Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures.

Cardiovascular risk is also increased in the obese patient. Results: Eight men and 32 women were enrolled and 1 subject had incomplete data. Obesity is often associated with obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. Neuromuscular monitoring should always be used whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs.

A useful bedside technique to determine whether the lung is prone to collapse is the measurement of transpulmonary pressure. Palavras chave:. Chest, 99pp. According to the World Health Organization, obesity has doubled sincewith a prevalence that is continuing to rise. Is the risk related to the personnel, the equipment or the training, or how much is related to anatomical or physiological changes in the critically ill patient?

Thirty-one of the 40 subjects had polysomnography-confirmed OSA. Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil for maintenance of anesthesia. Results: Eight men and 32 women were enrolled and 1 subject had incomplete data. Publication types Research Support, N. In the first 24 h postoperatively, there was no difference in the median Spo 2 with and without oxygen therapy, between OSA and non-OSA groups.

Thirty-one of the 40 subjects had polysomnography-confirmed OSA. In the first copmlications h postoperatively, there was no difference in the median Spo 2 with and without oxygen therapy, between OSA and non-OSA groups. Publication types Research Support, N. The obese patient is at risk of postoperative complications: difficult airway management, acute respiratory failure following extubation due to atelectasis and airway obstruction, added to morphine overdosing.

Neuromuscular monitoring should always be complicationss whenever neuromuscular blocking drugs are used, as depth of anaesthesia monitoring, especially when total intravenous anaesthesia is used in conjunction with neuromuscular blocking drugs. Publication types Research Support, N. Anesthetic management was standardized, using propofol for induction and desflurane and remifentanil for maintenance of anesthesia. A finger pulse oximetry probe was placed preoperatively and oxygen saturation Spo 2 was recorded continuously.

In general, monitoring of the obese patient is no different patiejts monitoring of other patients who are mechanically ventilated. However, the definitions used for the recorded variables, that is, difficult intubation, risk factors for difficult intubation, or severe life-threatening complications, were the same in both databases. Domi, H. Conflict of Interest: None declared.

  • Inability to breathe deeply when requested to by the PACU nurse. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery.

  • Cardiovascular risk is also increased in the obese patient.

  • Groeben, J.

  • All subjects underwent preoperative polysomnography testing within 4 wk of surgery. Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia.

Only with this baseline information can the increased rate of difficult intubations be related to being obese on ICU as opposed to simply being on ICU. Witt, R. Boussignac CPAP in the postoperative period in morbidly obese patients. Br J Anaesth ; 5 : —

Patient-controlled analgesia programmed to deliver morphine, 1 mg. The role of preoperative screening of Patiengs is crucial, with adequate management based on continuous positive pressure before, during and after surgery. All post op complications in obese patients airway underwent preoperative polysomnography testing within 4 wk of surgery. Sedatives, analgesics, and anesthetics alter airway tone, and airway obstruction and death have been reported in patients with OSA after minimal doses of sedatives and anesthetics, yet there is a lack of consensus regarding the care of these patients. Publication types Research Support, N. Publication types Review. Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia.

Mr Fisher has disclosed a relationship with Hollister. Molinari, Y. Post op complications in obese patients airway study addressed the problem of atelectasis complicatioms its onset, rather than after a period of time had passed during which atelectasis could form. Last available follow-up information was used for 93 patients 2. The lower lung volumes in obesity caused by the influence of the chest wall have a vastly different pathophysiology than the lower lung volumes associated with ARDS, and thus the caution applied to the ARDS lung with regard to recruitment maneuvers and high PEEP is not warranted in the obese.

Byrne, J. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Methods A single-centre prospective analysis of postoperative complications complicationx patients undergoing general surgery was conducted, with a median follow-up time of 6. Obese patients stayed longer in the PACU, but they did not stay longer in the hospital. Multivariate analysis identified obesity and residual neuromuscular blockade as independent risk factors for the occurrence of AREs.

Confidentiality of data. Poost of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. To analyze the outcome we obtained the following data: length of hospital stay LOSblood loss, operating time and the presence of postoperative complications, e. Table 2 presents specific variables recorded in the ICU cohort according to difficult intubation in obese patients. Khuri, et al. Reboul-Marty, P. One point attributed to the presence of each risk factor Full table.

  • This is supported by a systematic review of the use of post-operative NIV and CPAPof which 19 of 29 studies observed improved gas exchange, 11 reported a reduced re-intubation rate and one study showed NIV improved clinical outcome

  • Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia. Abstract Introduction: The increased incidence of morbid obesity has resulted in an increase of bariatric surgical procedures.

  • Additionally, there is further evidence of the differences between the two groups of patients in the method of intubation utilised.

  • Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia.

  • Our data confirm that morbidly obese subjects, with or without OSA, experience frequent oxygen desaturation episodes postoperatively, despite supplemental oxygen therapy suggesting that perioperative management strategies in morbidly obese patients undergoing laparoscopic bariatric surgery should include measures to prevent postoperative hypoxemia.

  • All subjects underwent preoperative polysomnography testing within 4 wk of surgery.

Conclusions: In morbidly obese subjects, in the first 24 h after laparoscopic bariatric surgery, OSA does not seem to increase the risk of postoperative hypoxemia. Abstract Obesity is often associated compkications obstructive sleep apnea OSAwhich increases the risk of intraoperative and postoperative complications. Obstructive sleep apnea OSA is a commonly encountered comorbidity in morbidly obese patients. Appropriate prophylaxis against venous thromboembolism VTE after assessment of risk benefit ratio and early mobilisation are recommended since the incidence of venous thromboembolism is increased in the obese. Results: Eight men and 32 women were enrolled and 1 subject had incomplete data.

Preoperative screening of cardiovascular complications complications obese appropriate therapy, combined to per- and postoperative hemodynamic optimization with a close monitoring allow to limit the cardiovascular risk. Atelectasis impairs gas exchange and increases physiological shunt, ventilation-perfusion mismatch, and work of breathing. There is a growing evidence base in a number of key areas, in particular, around optimal ventilation strategies to minimize the risk of immediate post-operative pulmonary complications Table 5. Futier, P. Respiratory Care in the Postanesthesia Care Unit and Postextubation Postoperative pulmonary considerations in the postanesthesia care unit are similar to those of the intraoperative phase: keeping the lung open and preventing atelectasis should be the primary concerns of the anesthesiologist see Table 2.

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