Anesthesia in the obese

Lebuffe, Gilles; Andrieu, Guillaume P.; Wierre, F.; Gorski, K.; Sanders, V.; Chalons, N.; Vallet, B.

doi:10.1016/j.jviscsurg.2010.08.013

Cited by 7 publications

(6 citation statements)

References 88 publications

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“…However, in the literature, PEEP applied after the recruitment maneuver and less than 80% FiO 2 administration methods recommended to maintain physiological oxygenation [15,16]. Lung-protective ventilation strategy (aproximately 8 ml kg −1 tidal volume and administered using estimated true body weight), PEEP administration, and alveolar recruitment maneuvers prevent atelectasis and positively affect intraoperative gas exchange which prevents the development of hypoxemia [12,17]. High PEEP administration prevents the decrease in lung volume at the end of expirium formed by increased intraabdominal pressure and in this way is reported to have positive effects on respiratory mechanics, gas exchange, and PaO 2 values in morbidly obese patients [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Atelectasis is fully resorbed 24 h after the end of the surgical procedure for nonobese patients, while atelectasis was shown to continue in obese patients at this point [11]. One of the most important aims of anesthesia management during operations on obese patients is to keep the airway and alveoli open during respiration [12]. The techniques of keeping airway pressure high for a duration to open atelectatic areas with the "recruitment maneuver" (RM) and positive expiration end pressure (PEEP) may reduce atelectasis and increase oxygenation [13].…”

Section: Purposementioning

confidence: 99%

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Effect of the “Recruitment” Maneuver on Respiratory Mechanics in Laparoscopic Sleeve Gastrectomy Surgery

et al. 2020

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Purpose LSG surgery is used for surgical treatment of morbid obesity. Obesity, anesthesia, and pneumoperitoneum cause reduced pulmoner functions and a tendency for atelectasis. The alveolar "recruitment" maneuver (RM) keeps airway pressure high, opening alveoli, and increasing arterial oxygenation. The aim of our study is to research the effect on respiratory mechanics and arterial blood gases of performing the RM in LSG surgery. Materials and Methods Sixty patients undergoing LSG surgery were divided into two groups (n = 30) Patients in group R had the RM performed 5 min after desufflation with 100% oxygen, 40 cmH 2 O pressure for 40 s. Group C had standard mechanical ventilation. Assessments of respiratory mechanics and arterial blood gases were made in the 10th min after induction (T1), 10th min after insufflation (T2), 5th min after desufflation (T3), and 15th min after desufflation (T4). Arterial blood gases were assessed in the 30th min (T5) in the postoperative recovery unit. Results In group R, values at T5, PaO 2 were significantly high, while PaCO 2 were significantly low compared with group C. Compliance in both groups reduced with pneumoperitoneum. At T4, the compliance in the recruitment group was higher. In both groups, there was an increase in PIP with pneumoperitoneum and after desufflation this was identified to reduce to levels before pneumoperitoneum. Conclusion Adding the RM to PEEP administration for morbidly obese patients undergoing LSG surgery is considered to be effective in improving respiratory mechanics and arterial blood gas values and can be used safely.

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Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

Effect of the “Recruitment” Maneuver on Respiratory Mechanics in Laparoscopic Sleeve Gastrectomy Surgery

et al. 2020

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“…The majority of post-operative AKI is thought to result from renal hypoperfusion or acute tubular necrosis. 7, 8 Obese surgical patients are at an increased risk for hypoperfusion as the intra-operative volume resuscitation required to minimize the risk of AKI is often underestimated in the obese patient. 9 Similarly, obesity is associated with multiple independent risk factors for post-operative AKI including chronic kidney disease (CKD), diabetes and heart failure.…”

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury, Renal Function, and the Elderly Obese Surgical Patient

Kelz¹,

Reinke²,

Zubizarreta³

et al. 2013

Annals of Surgery

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Objective To investigate the association between obesity and perioperative acute kidney injury (AKI), controlling for preoperative kidney dysfunction. Summary Background Data More than 30% of patients over the age of 60 are obese, and therefore at risk for kidney disease. Post-operative AKI is a significant problem. Methods We performed a matched case control study of patients enrolled in the Obesity and Surgical Outcomes Study (OBSOS), using Medicare claims data enriched with detailed chart review. Each AKI patient was matched to a non-AKI control similar in procedure type, age, sex, race, emergency status, transfer status, baseline eGFR, admission APACHE score, and the risk of death score with fine balance on hospitals. Results We identified 514 AKI cases and 694 control patients. Of the cases, 180 (35%) followed orthopedic procedures and 334 (65%) followed colon or thoracic surgery. After matching, obese patients undergoing a surgical procedure demonstrated a 65% increase in odds of AKI within 30 days from admission (OR=1.65, p<0.005) when compared to the non-obese patients. After adjustment for potential confounders, the odds of post-operative AKI remained elevated in the elderly obese (OR=1.68, p=0.01.) Conclusions Obesity is an independent risk factor for post-operative AKI in patients over 65 years of age. Efforts to optimize kidney function pre-operatively should be employed in this at risk population along with keen monitoring and maintenance of intra-operative hemodynamics. When subtle reductions in urine output or a rising creatinine are observed post-operatively, timely clinical investigation is warranted to maximize renal recovery.

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“…Routine screening for phlebothrombosis by duplex sonography is not mandatory in the obese but recommended in patients with pulmonary hypertension or antecedent deep vein thrombosis [26]. …”

Section: Thromboembolic Risk Assessmentmentioning

confidence: 99%

Where to Begin and Where to End? Preoperative Assessment for Patients Undergoing Metabolic Surgery

et al. 2014

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Bariatric surgery is the most effective treatment of obesity and its associated diseases like type 2 diabetes mellitus. Given the obesity epidemic and the efficacy of surgical treatment, the number of surgical weight loss procedures has grown in recent years. Nevertheless, there is little consensus regarding the extent of preoperative investigations required prior to patients undergoing surgery. This article aims to discuss the available evidence on which preoperative tests are useful for the detection and treatment of conditions such as venous thromboembolism, obstructive sleep apnea syndrome and Helicobacter pylori-positive gastritis prior to an operation. The present literature suggests that only a few preoperative investigations are essential, but that preoperative multidisciplinary care is beneficial.

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Anesthesia in the obese

Cited by 7 publications

References 88 publications

Effect of the “Recruitment” Maneuver on Respiratory Mechanics in Laparoscopic Sleeve Gastrectomy Surgery

Effect of the “Recruitment” Maneuver on Respiratory Mechanics in Laparoscopic Sleeve Gastrectomy Surgery

Acute Kidney Injury, Renal Function, and the Elderly Obese Surgical Patient

Where to Begin and Where to End? Preoperative Assessment for Patients Undergoing Metabolic Surgery

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