Anestesia para obesidade mórbida

Lorentz, Michelle Nacur; Albergaria, Viviane Ferreira; Lima, Frederico Augusto Soares de

doi:10.1590/s0034-70942007000200010

Cited by 17 publications

(5 citation statements)

References 69 publications

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“…The muscular and adipose tissue of obese patients responds less to insulin action due to a decrease in the number of receptors and a lower response created by the insulin---receptor interaction. 27 In obese patients, the cortisol production is also altered, increasing the peripheral resistance to insulin. In a study with 50,905 adults, it was shown that BMI is an independent predictor for diabetes, with three times higher prevalence in patients with BMI >24.…”

Section: Discussionmentioning

confidence: 99%

Hyperglycemia assessment in the post-anesthesia care unit

Pereira

Azuma

Gatto

et al. 2017

Brazilian Journal of Anesthesiology (English Edition)

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Background and objectives: Hyperglycemia in surgical patients may cause serious problems. Analyzing this complication in this scenario contributes to improve the management of these patients. The aim of this study was to evaluate the prevalence of hyperglycemia in the postanesthetic care unit (PACU) in non-diabetic patients undergoing elective surgery and analyze the possible risk factors associated with this complication. Methods: We evaluated non-diabetic patients undergoing elective surgeries and admitted in the PACU. Data were collected from medical records through precoded questionnaire. Hyperglycemia was considered when blood glucose was >120 mg.dL −1 . Patients with hyperglycemia were compared to normoglycemic ones to assess factors associated with the problem. We excluded patients with endocrine-metabolic disorders, diabetes, children under 18 years, body mass index (BMI) below 18 or above 35, pregnancy, postpartum or breastfeeding, history of drug use, and emergency surgeries. Results: We evaluated 837 patients. The mean age was 47.8 ± 16.1 years. The prevalence of hyperglycemia in the postoperative period was 26.4%. In multivariate analysis, age (OR = 1.031, 95% CI 1.017---1.045); BMI (OR = 1.052, 95% CI 1.005---1.101); duration of surgery (OR = 1.011, 95% CI 1.008---1.014), history of hypertension (OR = 1.620, 95% CI 1.053---2.493), and intraoperative use of corticosteroids (OR = 5.465, 95% CI 3.421---8.731) were independent risk factors for postoperative hyperglycemia. Conclusion: The prevalence of hyperglycemia was high in the PACU, and factors such as age, BMI, corticosteroids, blood pressure, and duration of surgery are strongly related to this complication. PALAVRAS-CHAVECirurgia eletiva; Hiperglicemia; Prevalência; Fatores de risco; Sala de recuperação anestésica Avaliação de hiperglicemia na sala de recuperação pós-anestésicaResumo Justificativa e objetivos: Hiperglicemia em pacientes cirúrgicos pode ocasionar graves problemas. Nesse contexto, analisar essa complicação contribui para o melhor manejo desses pacientes. O objetivo do estudo foi avaliar a prevalência de hiperglicemia na sala de recuperação pós-anestésica (SRPA) em pacientes não diabéticos submetidos a cirurgias eletivas e analisar os possíveis fatores de risco associados a essa complicação. Métodos: Foram avaliados pacientes não diabéticos submetidos a cirurgias eletivas e admitidos na SRPA. Os dados foram coletados dos prontuários por meio de questionário pré-codificado. Foi considerada hiperglicemia quando a glicemia era > 120 mg.dL −1 . Pacientes com hiperglicemia foram comparados com os normoglicêmicos para avaliar fatores associados ao problema. Foram excluídos os pacientes com distúrbios endócrino-metabólicos, diabéticos, menores de 18 anos, índice de massa corpórea (IMC) menor do que 18 ou maior do que 35, gestação, puerpério ou aleitamento materno, antecedente de uso de drogas e cirurgias de urgência. Resultados: Foram avaliados 837 pacientes. A média de idade foi 47,8 ± 16,1 anos. A prevalên-cia de hiperglicemia n...

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Section: Discussionmentioning

confidence: 99%

Hyperglycemia assessment in the post-anesthesia care unit

Pereira

Azuma

Gatto

et al. 2017

Brazilian Journal of Anesthesiology (English Edition)

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“…The decreased pulmonary function after surgical procedures can be explained by factors inherent to the procedure itself, such as the use of anesthetics and analgesics, the loss of integrity of the abdominal muscles and the consequent decrease in muscle contraction force and diaphragmatic dysfunction, as well as by factors that interfere in performing spirometric maneuvers, such as pain and fear of deep inspiration 6 , 36 . In this study, there was concern about assessing pain and requesting the administration of analgesics according to medical prescription before the postoperative evaluations, when necessary, to prevent the results from being affected by this factor.…”

Section: Discussionmentioning

confidence: 99%

Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

Brigatto¹,

Carbinatto²,

Costa³

et al. 2014

Braz. J. Phys. Ther.

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Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20), IPPB Group (n=20) and BIPAP Group (n=20), then received the corresponding intervention: positive expiratory pressure (EPAP), inspiratory positive pressure breathing (IPPB) or bilevel inspiratory positive airway pressure (BIPAP), in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy. Results: There was a significant postoperative reduction in spirometric variables (p<0.05), regardless of the technique used, with no significant difference among the techniques (p>0.05). Thoracic mobility was preserved only in group BIPAP (p>0.05), but no significant difference was found in the comparison among groups (p>0.05). Conclusion: The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques.

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“…Os procedimentos cirúrgicos, especialmente do andar superior do abdome, como a cirurgia bariátrica, produzem efeitos deletérios no sistema respiratório, como alterações na troca gasosa e na mecânica respiratória. O tempo cirúrgico e os anestésicos empregados acarretam maior chance de ocorrência de complicações pulmonares pós-operatórias [8]. Neste contexto, diversos autores relatam que pacientes submetidos à cirurgia bariátrica podem evoluir com complicações respiratórias [9].…”

Section: Introductionunclassified

Intervenções fisioterapêuticas na função pulmonar em pacientes submetidos a cirurgia bariátrica

et al. 2018

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O objetivo desta pesquisa foi buscar na literatura evidências sobre intervenções utilizadas pela fisioterapia em pacientes submetidos a cirurgia bariátrica. Métodos: As buscas foram realizadas nos meses de janeiro e fevereiro de 2018, através do acesso online em bases de dados: Pubmed/Medline, PEDro, Scielo e Lilacs. Utilizou estratégia PICo, onde foram definidos: População (P): Obesidade Mórbida; Interesse (I): Prática baseada em evidências; Contexto (Co): estudos de intervenções. Resultados: Através das estratégias de busca foram encontrados 951 artigos. Após leitura dos resumos, observados critérios de inclusão e exclusão, foram excluídos um total de 901, restando 50 artigos que foram lidos na íntegra e, em seguida, elegeram-se 10 estudos. As evidências das intervenções do treinamento muscular respiratório podem ser observadas nos ensaios clínicos contendo bom rigor metodológico. O treinamento muscular respiratório pode ser considerado como uma intervenção, juntamente com outras terapêuticas (dois níveis de pressão – Bilevel) que compõem o tratamento de pacientes submetidos à cirurgia bariátrica, auxiliando na obtenção de resultados satisfatórios. Conclusão: O nível de evidência atualmente disponíveis do impacto das intervenções fisioterapêuticas, como o treinamento muscular respiratório, na função pulmonar de pacientes submetidos à cirurgia bariátrica se mostrou alto. A análise metodológica realizada neste estudo mostrou poucos números de estudos de ensaios clínicos, retratando a real necessidade de novos estudos que possam integrar a pratica clínica.Palavras-chave: cirurgia bariátrica, estudos de intervenção, fisioterapia respiratória.

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Anestesia para obesidade mórbida

Cited by 17 publications

References 69 publications

Hyperglycemia assessment in the post-anesthesia care unit

Hyperglycemia assessment in the post-anesthesia care unit

Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

Intervenções fisioterapêuticas na função pulmonar em pacientes submetidos a cirurgia bariátrica

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