Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Conclusions In obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.
Source: Anesthesiology - Category: Anesthesiology Source Type: research

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Publication date: December 2017Source: Best Practice &Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Adrian Sultana, David Torres, Roman SchumannOpioid-free anaesthesia (OFA) is a technique where no intraoperative systemic, neuraxial or intracavitary opioid is administered with the anaesthetic. Opioid-free analgesia similarly avoids opioids in the perioperative period.There are many compelling reasons to avoid opioids in the surgical population.A number of case reports and, increasingly, prospective studies from all over the world support its benefits, especially in the morbidly obese population with o...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
AbstractPurpose of ReviewThe purpose of this article is to provide a brief review of the preoperative pulmonary evaluation of patients undergoing non-thoracic surgery, focusing on risk factor identification, assessment of specific high-risk populations, and strategies to minimize postoperative pulmonary complications (PPCs).Recent FindingsAlong with traditional risk factors, recent risk stratification indices have been developed and validated to help quantify risk of PPCs. Careful history and physical examination are key elements in the pulmonary evaluation of all pre-surgical patients. Patients with chronic obstructive pu...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
Purpose of review The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period. Recent findings In the postoperative period, OIRD has often been reported resulting in morbidity and mortality. The risk factors which predispose surgical patients to increased risk of OIRD are not clearly defined. A literature search was performed for adult surgical patients who were prescribed opioids during their hospital stay and any available reports on postoperative respiratory depression/respiratory events. Summary Elderly, female sex, presence o...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research
Publication date: Available online 16 November 2017 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Roman Schumann, Adrian Sultana, David Torres Opioid Free Anesthesia is a technique where no intra-operative systemic, neuraxial, or intra-cavitary opioid is administered during the anesthetic. Opioid Free Analgesia similarly avoids opioids in the perioperative period. There are many compelling reasons to avoid opioids in the surgical population. A number of case reports and increasingly, prospective studies from all over the world support its benefits especially in the morbidly obese population with ...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research
CONCLUSIONS: Claims related to outpatient medication management in pain medicine are multifactorial, stemming from deficits in clinical judgment by physicians, noncooperation in care by patients, and poor clinical documentation. Minimization of both legal risk and patient harm can be achieved by carefully selecting patients for chronic opioid therapy and documenting compliance and improvement with the treatment plan. Medical comorbidities such as obstructive sleep apnea and the use of long-acting opioids may be particularly dangerous. Continuing physician education on the safest and most effective approaches to manage thes...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
CONCLUSION: We found a marginal association between BMI and an increased risk of developing AKI in adult patients after having noncardiac laparoscopic surgery. The BMI effect became insignificant when potential mediator variables were considered. The association of BMI and AKI after noncardiac laparoscopic surgery is likely mediated through components of the metabolic syndrome. PMID: 29026353 [PubMed]
Source: Ochsner Journal - Category: General Medicine Tags: Ochsner J Source Type: research
Conclusions: Peroral arsenic has little effect on local airway immune responses to bacteria but compromises respiratory epithelial barrier integrity, increasing systemic translocation of inhaled pathogens and small molecules. https://doi.org/10.1289/EHP1878 Received: 09 March 2017 Revised: 14 August 2017 Accepted: 16 August 2017 Published: 28 September 2017 Address correspondence to M.B. Fessler, National Institute of Environmental Health Sciences, 111 T.W. Alexander Dr., P.O. Box 12233, Maildrop D2-01, Research Triangle Park, NC 27709 USA. Telephone: (919) 541-3701. Email: fesslerm@niehs.nih.gov *Current address: UN...
Source: EHP Research - Category: Environmental Health Authors: Tags: Research Source Type: research
A 63-year-old man with a medical history of obesity (BMI 32), complicated by chronic obstructive pulmonary disease, diabetes, and hypertension was admitted to the emergency department (ED) following a car accident. While in the ED, the patient was fully collaborative (GSC 15), hemodynamically stable, and visibly suffering from chest pain. Self-reported pain intensity originating mainly from the right side of the thorax was 9 –10, as measured on the numeric rating scale (NRS).
Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
Purpose of review: The prevalence of sleep disordered breathing (SDB) is increasing proportional to the prevalence of obesity. Although anesthesiologists are familiar with obstructive sleep apnea (OSA) – the most common SDB, anesthesiologists may not be aware of other SDB such as obesity hypoventilation syndrome (OHS) and overlap syndrome (combination of OSA and chronic obstructive pulmonary disease). The present review provides an update of information regarding the perioperative management of OHS and overlap syndrome. Recent findings: OHS and overlap syndrome are associated with significant comorbid conditions and...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances Chung Source Type: research
Abstract AimThe perineal wound following abdominoperineal excision (APR) is associated with a high complication rate. We aimed to evaluate the risk factors for wound complications and examine the effect of flap reconstruction on wound healing. MethodThe American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was searched for patients who underwent APR for rectal adenocarcinoma. They were divided into two groups: primary closure of the perineal wound and flap reconstruction. A logistic regression analysis was performed to identify the risk factors for deep surgical site infection (SSI) an...
Source: Colorectal Disease - Category: Gastroenterology Authors: Tags: Original Article Source Type: research
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