Preoperative risk and perioperative management of obese patients.

[Preoperative risk and perioperative management of obese patients]. Rev Mal Respir. 2019 Sep 11;: Authors: De Jong A, Verzilli D, Chanques G, Futier E, Jaber S Abstract The obese patient is at an increased risk of perioperative complications. Most importantly, these include difficult access to the airways (intubation, difficult or impossible ventilation), and post-extubation respiratory distress secondary to the development of atelectasis or obstruction of the airways, sometimes associated with the use of morphine derivatives. The association of obstructive sleep apnea syndrome (OSA) with obesity is very common, and induces a high risk of peri- and postoperative complications. Preoperative OSA screening is crucial in the obese patient, as well as its specific management: use of continuous positive pre, per and postoperative pressure. For any obese patient, the implementation of protocols for mask ventilation and/or difficult intubation and the use of protective ventilation, morphine-sparing strategies and a semi-seated positioning throughout the care, is recommended, combined with close monitoring postoperatively. The dosage of anesthetic drugs should be based on the theoretical ideal weight and then titrated, rather than dosed to the total weight. Monitoring of neuromuscular blocking should be used where appropriate, as well as monitoring of the depth of anesthesia. The occurrence of intraoperative recall is indeed more frequent in the obese patient than...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research

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PMID: 31624879 [PubMed - as supplied by publisher]
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
This study evaluated the validity of existing OSA screening tools in a cohort of extremely obese pregnant women [body mass index (BMI) ≥40 kg/m2] and determined what screening factors were most strongly associated with OSA in this cohort.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research
This study demonstrated ultrasonography in predicting difficult laryngoscopy lacked utility. Ultrasound utilization as an efficacious means of difficult airway assessment requires further research with a larger sample size. Further studies using sonography on those patients with known difficult airways may provide data to determine if ultrasound has utility in predicting difficult laryngoscopy.
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research
Obstructive sleep apnea (OSA) is a disorder characterized by breathing cessation caused by obstruction of the upper airway during sleep. It is associated with multiorgan comorbidities such as obesity, hypertension, heart failure, arrhythmias, diabetes mellitus, and stroke. Patients with OSA have an increased prevalence of ophthalmic disorders such as cataract, glaucoma, central serous retinopathy (detachment of retina, macular hole), eyelid laxity, keratoconus, and nonarteritic anterior ischemic optic neuropathy; and some might require surgery.
Source: Journal of Cataract and Refractive Surgery - Category: Opthalmology Authors: Tags: Review/update Source Type: research
Purpose of review With new medical technologies and changing life styles, maternal demographics has changes and consequently older and sicker women are becoming pregnant. In this review, we present these different high-risk parturient populations, which were once considered rare for the practicing obstetric anesthesiologist. Recent findings With lifestyle and medical advances, older and sicker women are getting pregnant. Older women are more prone to pregnancy complications. Cancer survivors are becoming pregnant and more pregnant women are being diagnosed with cancer. Previous neurological and cardiac conditions con...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Emilia Guasch and Manuel Wenk Source Type: research
Conclusion: These findings limit the possible roles of gene transcriptional changes in previously reported age-dependent pro-arrhythmic electrophysiologial changes observed in Pgc-1β-/- atria to an altered Ca2+-ATPase (Atp2a2) expression. This directly parallels previously reported arrhythmic mechanism associated with p21-activated kinase type 1 deficiency. This could add to contributions from the direct physiological outcomes of mitochondrial dysfunction, whether through reactive oxygen species (ROS) production or altered Ca2+ homeostasis. Introduction Atrial arrhythmias constitute a major public health probl...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Abstract The prevalence of obesity has substantially increased worldwide during the last ten years. Hence, more anaesthetic procedures will be performed in obese patients in the future and more hospitals have to be prepared for the perioperative treatment of extremely obese patients including medical, technical and organisational issues. These include not only the management of the perioperative problems of adiposity, but also of its numerous concomitant diseases. Besides hyperlipidemia, diabetes mellitus, arterial hypertension and coronary heart disease, the obstructive sleep-apnea syndrome (OSAS) challenges the ...
Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS - Category: Intensive Care Authors: Tags: Anasthesiol Intensivmed Notfallmed Schmerzther Source Type: research
Hypoxia is a major concern and cause of morbidity or mortality during tracheal intubation after anesthesia induction in a pathological obese patient with obstructive sleep apnea (OSA). We introduce a case usin...
Source: BMC Anesthesiology - Category: Anesthesiology Authors: Tags: Case report Source Type: research
Publication date: Available online 1 March 2019Source: Anesthesiology ClinicsAuthor(s): Gaganpreet Grewal, Girish P. Joshi
Source: Anesthesiology Clinics - Category: Anesthesiology Source Type: research
(Anesth Analg. 2018;127:1167–1177) Sleep-disordered breathing (SDB) is often comorbid with obesity; among obese pregnant women, 15% to 20% have obstructive sleep apnea (OSA), and prevalence increases with body mass index (BMI). Untreated OSA has been associated with a range of cardiovascular, pulmonary, and metabolic comorbidities. The authors of this review discussed pregnancy as a vulnerable period for the development or worsening of OSA, associations between OSA and adverse maternal and fetal outcomes, current screening modalities for OSA in pregnancy, and current recommendations regarding peripartum management of OSA.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Editorials and Reviews Source Type: research
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