The patients with banded gastric bypass had significantly better results in terms of weight loss, weight stability and Gastrointestinal Quality of Life Index scores at 2 years.

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and grade IV (ventilation inadequate with no PE ′ CO 2 measurement and no perceptible chest wall movement during attempts at positive pressure ventilation) in one patient (0.5%) (grades I and II, and grades III and IV being equivalent to scores ,3 and 3 or more, respectively, used by Roberts and colleagues). Thus, of those 188 patients with predicted difficult BMV, barely 7% actually demonstrated difficult BMV. This is less than half the incidence reported by Roberts and colleagues. 1 It is conceivable that the higher incidence in the latter report was caused by the absence of muscle relaxation at the time of assessment of BMV.In patients with ,3 risk factors, the quality of BMV was assessed before administration of a neuromuscular blocking agent. After the administration of succinylcholine in 90 patients with BMV difficulty grade III, the quality of BMV improved by one grade in 56 (62%), and did not worsen in any of the remaining 34 patients. After administration of a nondepolarizing neuromuscular blocking agent in 12 003 patients with BMV difficulty grade I and II, the quality of BMV did not worsen in a single patient. These findings confirm previous ones showing that in patients with unimpaired 3 or with a mix of unimpaired and moderately difficult BMV, 4 the quality of BMV either remained unchanged or improved after the administration of a neuromuscular blocking agent, but never worsened.During the past 25 yr, in the absence of indication for awake fibreoptic tracheal intubation, I have routinely administered the planned full dose of the neuromuscular blocking agent as soon as the patient went off to sleep. With this practice, I have rarely encountered impossible BMV. In my view, lack of administration of muscle relaxation immediately after induction of anaesthesia should be considered a predictor of difficult BMV. I fully agree with the authors' statement that BMV is 'a vital, life-saving skill for anaesthetists' 1 (although with the advent of supraglottic airway devices, the importance of BMV has somewhat diminished). However, BMV may iatrogenically be made difficult by the reluctance of early muscle relaxation. 1 Roberts S, Cyna AM, Walsh JP, Davis JS. Assessment of anaesthetists' ability to predict difficulty of bag-mask ventilation. Br J Anaesth 2013; 111: 676-7 2 Amathieu R, Combes X, Abdi W, et al. An algorithm for difficult airway management, modified for modern optical devices (Airtraq laryngoscope; LMA CTrach TM ): a 2-year prospective validation in patients for elective abdominal, gynecologic, and thyroid surgery. Anesthesiology 2011; 114: 25-33 3 Goodwin MWP, Pandit JJ, Hames K, Popat M, Yentis SM. The effect of neuromuscular blockade on the efficiency of mask ventilation of the lungs. Anaesthesia 2003; 58: 60-3 4 Warters RD, Szabo TA, Spinale FG, DeSantis SM, Reves JG. The effect of neuromuscular blockade on mask ventilation.

Background and Aims: Effects of fluid absorption on hematological profile in the immediate postoperative period in patients undergoing percutaneous nephrolithotomy (PCNL) have not been given due importance. Considering the limited number of studies available, we conducted this study to evaluate the changes in hemodynamics, complete blood count (CBC), and electrolytes in patients undergoing PCNL using normal saline for irrigation in the prone position. Furthermore, we evaluated the common factors known to affect the absorption. Materials and Methods: Forty American Society of Anesthesiologist Class I or II patients aged 18–65 years were recruited who underwent PCNL under general anesthesia. Heart rate, blood pressure (BP), CBC, and serum electrolytes were recorded preoperatively and just before extubation and compared using the Student's t -test. Correlation of these changes with height and total volume of irrigating fluid, total time of irrigation, duration of operation, and total intravenous fluids administered intraoperatively were performed using the Pearson's correlation coefficient. Results: There was a statistically significant fall in mean hemoglobin (12.5 g/dL to 11.5 g/dL), packed cell volume (38.6%–35.6%), platelet count (2.9 × 10 5 cells/μL to 2.5 × 10 5 cells/μL), and sodium ion concentration (Na + ) (138.9 meq/L to 137.7 meq/L) in the immediate postoperative period as compared to that of the preoperative values. Rest of the blood indices and electrolytes did not show any significant change. There was a significant rise in postoperative heart rate and BP. Postoperative systolic BP showed a significant positive correlation with the total volume of irrigating fluid. No significant correlation was observed with height and total time of irrigation. Conclusion: This study reveals that there is a significant fall in hemoglobin and Na + during PCNL in the immediate postoperative period. Only, total volume of irrigating fluid and total duration of surgery had a significant correlation with blood cell indices.

Background:The effect of positive end-expiratory pressure (PEEP) has been studied in detail after induction of general anesthesia especially in obese individuals. However, sparse information can be gathered from the literature regarding its effect when applied at the time of induction and the time of onset of its effect. Thus, this study was planned to assess the effect of PEEP when applied for a single minute in morbidly obese patients.Materials and Methods:This was a randomized prospective study comprising seven morbidly obese patients (body mass index ≥40 kg/m2). Control group included 30 patients who received no PEEP at the time of induction. The study group consisted of thirty patients who were given a PEEP of 10 cmH2O. Serial arterial blood gas samples were taken preoperatively, at the time of intubation, 5 min after intubation and 10 min after intubation.Results:PaO2 was significantly higher in test group (242.0 ± 116.0 mmHg) than in control group (183.0 ± 107.0 mmHg) just after intubation. PaCO2 was comparable in control group (43.73 ± 6.32 mmHg) and test group (44.52 ± 6.33 mmHg) just after intubation but was significantly less in test group than in control group at 5 and 10 min thereafter. Hemodynamic parameters were comparable in both groups at all time intervals.Conclusion:Application of even a single minute of PEEP at the time of induction improves oxygenation without any adverse effects on hemodynamics, in morbidly obese patients undergoing laparoscopic Bariatric surgery.