Office-based anesthesia: an update on safety and outcomes (2017–2019)

Purpose of review Although both cost and patient preference tend to favor the office-based setting, one must consider the hidden costs in managing complications and readmissions. The purpose of this review is to provide an update on safety outcomes of office-based procedures, as well as to identify common patient-specific factors that influence the decision for office-based surgery or impact patient outcomes. Recent findings Office-based anesthesia (OBA) success rates from the latest publications of orthopedic, plastic, endovascular, and otolaryngologic continue to improve. A common thread among these studies is the ability to predict which patients will benefit from going home the same day, as well as identifying comorbid factors that would lead to failure to discharge or readmission after surgery. Specifically, patients with active infection, cardiovascular disease, coagulopathy, insulin-dependent diabetes, obesity, obstructive sleep apnea, poorly controlled hypertension, and thromboembolic disease are presumed to be poor candidates for outpatient office procedures. Summary Overall, anesthesia and surgery in the office is becoming increasingly safe. Recent data suggest that the improved safety in the office-based setting is attributable to proper patient selection. Anesthesiologists play a critical role in prescreening eligible patients to ensure a safe and productive process. Patients treated in the office seem to be selected based on their low risk for complicatio...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

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CONCLUSIONS In middle-aged and elderly individuals without CKD, arterial stiffness determined by obesity, dyslipidemia and increased pulse pressure, was significantly associated with increased serum levels of cystatin C. PMID: 31793519 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
Publication date: Available online 30 November 2019Source: Obesity Research &Clinical PracticeAuthor(s): Maya Tsao-Wu, Ronald J. Williams, Helen M. Hendy, Marsha B. NovickAbstractBackgroundChildhood obesity has increased dramatically in the United States. Most available research has followed obesity prevalence with little attention to medical comorbidities, which could guide prevention and intervention.MethodsA retrospective chart review examined 2038 children referred to a Pediatric Weight Management Clinic providing low intensity (26 contact hours for changes in diet, exercise, screen time) for reducing obesity sever...
Source: Obesity Research and Clinical Practice - Category: Eating Disorders & Weight Management Source Type: research
ConclusionOAGB provided very good weight loss, comorbidity improvement, and quality of life at follow-up of ≥ 5 years.
Source: Obesity Surgery - Category: Surgery Source Type: research
Authors: Sanches E, Timmermans M, Topal B, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S, Proczko M, Stepaniak PS, Pujol Rafols J, Mahawar K, Buise MP, Neimark A, Severin R, Pouwels S Abstract Introduction: Obesity is associated with various diseases such as type 2 diabetes, hypertension, obstructive sleep apnea syndrome (OSAS), metabolic syndrome, and cardiovascular diseases. It affects several organ systems, including the pulmonary and cardiac systems. Furthermore, it induces pulmonary and cardiac changes that can result in right and/or left heart failure.Areas covered: In this review, authors provide an overv...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
This study was conducted among consecutive adults, who were admitted to the Department of Pulmonary Medicine, Marmara University, Istanbul between November 2015 and October 2018. Participants answered the questionnaires and underwent a sleep study with cardiorespiratory polygraphy. OSA was defined as an Apnoe-Hypopnoe-Index (AHI)≥15/h.In all, 1042 adults (334 women; 32.1%) were included. OSA was diagnosed in 589 (56.5%). In the OSA group, women were older (53.7±11.5 vs 47.8± 12.8 yrs; p
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sleep and control of breathing Source Type: research
Conclusion: The present study demonstrated an association between fibrosis, a finding of worse prognosis in patients with NAFLD, and moderate to severe OSA, regardless of obesity.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sleep and control of breathing Source Type: research
Background: Cardio-metabolic risk and clinical presentation profile in obstructive sleep apnea (OSA) differs between men and women.Objective: To evaluate the influence of gender on OSA-related symptoms and prevalent cardio-metabolic disease in the European Sleep Apnea Database (ESADA) cohort.Methods: We identified a sample of 18,872 patients (mean age 52 years, 30% women) from the ESADA cohort with complete data from polygraphic or polysomnographic recordings and Epworth sleepiness scale (ESS). The predictive value of gender on associated symptoms and prevalent cardio-metabolic disease was investigated after adjustment for...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Epidemiology Source Type: research
Background: Altered sleep quality has been reported in chronic kidney disease (CKD). However, most studies focused on dialyzed patients or were based on subjective reports that did not consider possible coexistence of obstructive sleep apnea (OSA).Aim: To evaluate, with a case-control design, if objective sleep quality differs between patients with stage 3 CKD and subjects with normal estimated glomerular filtration rate (eGFR) independent of sleep disordered breathing.Methods: In the European Sleep Apnea Database (ESADA) cohort, 527 patients who had undergone full polysomnography and had an eGFR60.Results: CKD patients we...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sleep and control of breathing Source Type: research
ConclusionWLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.
Source: Obesity Surgery - Category: Surgery Source Type: research
sti R Abstract Protein carbonylation is a marker of oxidative protein damage, that is likely involved in the pathogenesis of several diseases. The aim of this study was to evaluate the protein carbonyl (PC) groups in different clinical conditions. It included different groups of subjects: 81 trained subjects; 23 subjects with mild essential hypertension; 31 middle-aged subjects with metabolic syndrome (MS); 106 subjects with MS not selected for age (subdivided into two subgroups, with and without diabetes mellitus); 91 obese adults subdivided in two subgroups (BMI 30-35 Kg/m2 and BMI > 35 kg/m2); 48 subject...
Source: Clinical Hemorheology and Microcirculation - Category: Hematology Authors: Tags: Clin Hemorheol Microcirc Source Type: research
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