Morbid obesity and the prone position: a case report

Brodsky, Jay B.; Oldroyd, Matthew; Winfield, Howard N.; Kozlowski, P.

doi:10.1016/s0952-8180(01)00230-6

Cited by 23 publications

(11 citation statements)

References 12 publications

(8 reference statements)

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“…Anaesthesiologists experienced with obese patients and prone positioning are preferred. Reduced lung functional residual capacity and total lung capacity, as well as reduced venous return from inferior vena cava compression may occur with prone obese patients . We acknowledge that supine positioning has been suggested to have possible advantages for obese patients over prone positioning, including shorter operating times ; however this must be balanced with the loss of nephroscope manoeuvrability associated with supine PCNL, which can be troublesome in super obese patients, as nephroscope mobility is already greatly hampered by patient anatomy .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

et al. 2015

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ObjectiveTo analyse our experience with and the outcomes and lessons learned from percutaneous nephrolithotomy (PCNL) in the super obese (body mass index [BMI] ≥50 kg/m 2 ). Patients and MethodsIn this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m 2 . Patient demographics, peri-operative outcomes and complications were determined. Additionally, we identified a number of special PCNL considerations in the super obese that can maximize safe outcomes. ResultsA total of 21 PCNL procedures performed on 17 super obese patients were identified. The mean patient age was 54.8 years, the mean BMI was 57.2 kg/m 2 and the mean stone area was 1 037 mm 2 . Full staghorn stones were observed in six patients and partial staghorns in four patients. The mean operating time was 106 min and the mean haemoglobin decrease was 1.2 g/dL. The overall stone-free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese, including using extra-long nephroscopes and graspers, using custom-cut extra long access sheaths with suture 'tails' secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding. ConclusionWith appropriate peri-operative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance was similar to that reported in previous PCNL series in the morbidly obese, and is achievable with few complications.

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Section: Discussionmentioning

confidence: 99%

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

et al. 2015

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“…Patients in the LA group were fully conscious during the operation, and were thus able to position themselves comfortably and quickly. Patients undergoing surgical procedures in the prone position under general anaesthesia may experience an increased incidence of a variety of complications [9, 10, 25–27]. The incidence of such complications may be substantially decreased if the patient is awake.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the complications that may result from general anaesthesia, the performance of the operation in the prone position provides further opportunities for patient morbidity that include decreased pulmonary compliance, cardiovascular instability and airway problems [9–12]. Different anaesthetic techniques have been introduced as an alternative to general anaesthesia.…”

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confidence: 99%

Sacrococcygeal local anaesthesia versus general anaesthesia for pilonidal sinus surgery: a prospective randomised trial

2003

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SummaryAt present there is no nationwide formal training course at which college tutors in anaesthesia can develop the specific skills required to perform their important role effectively. The purpose of this study was to ascertain whether there is a need for an introductory learning package for college tutors and if so, what learning needs ought to be addressed in such a package. A needs assessment was performed involving the use of individual interviews and the administration of two sequential questionnaires. The questionnaire was completed by 208 college tutors, a return rate of 83%. Most college tutors (93%) said they had had no formal training to perform their role and 94% felt there was a need for an introductory course for college tutors in anaesthesia. Of those, 77% said they would be interested in taking such a course. The study identified a number of learning needs. College tutors in anaesthesia currently acquire the skills to perform their role by a variety of means. At present, there is no nationwide formal training course at which they can develop the specific skills required to perform this important role effectively. This role is defined by the Royal College of Anaesthetists and includes responsibility for co-ordinating the professional development and pastoral care of trainees attached to their hospital department [1]. In addition, the role of the college tutor has been increasing in recent years. In 1996, the publication of the Calman report led to the introduction of more formalised and organised training for medical specialists [2]. College tutors have been closely involved in the implementation of this report. The speciality of anaesthesia has been one of the first to introduce a competency-based training programme, as recommended by the Specialist Training Authority [3]. The requirement for more frequent and formalised workplace-based appraisal and assessment has put further demands on college tutors.The General Medical Council and the Royal College of Anaesthetists also recommend that those with responsibility for training and assessment are equipped with the necessary skills [1, 4, 5].The study had two aims: 1 To ascertain whether there is a need for an introductory learning package for college tutors in anaesthesia.And if so, 2 What learning needs ought to be addressed in such a package? within the south-east of Scotland region to collect qualitative data. McKenna defined 'experts' as 'a panel of informed individuals ' [6]. The personnel interviewed consisted of four current college tutors in anaesthesia, one ex-tutor and one ex-regional advisor. All of these individuals have experience in the role of college tutor and four were key stakeholders in the project. The objective of these interviews was to draw up a list of educational objectives for an introductory learning package for college tutors in anaesthesia.The next step was to validate the objectives. A more extensive survey of anaesthetic college tutors was needed before further programme development could be instituted. This was un...

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“…Otherwise, cardiac venous return is diminished by compression onto the inferior vena cava and femoral veins, which in turn leads to decreased volume in the left ventricle, causing hypotension. Prone position in obese patients under anesthesia improves pulmonary functions and increase FRC, pulmonary compliance, and oxygenation [53,67].…”

Section: Intraoperative Management 31 Positioning In Morbidly Obesementioning

confidence: 99%

Obesity and Anesthesia Management

Demirel¹,

Bolat²,

Altun³

2017

Current Topics in Anesthesiology

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The prevalence of obesity is rapidly increasing throughout the world. Correspondingly, anesthetic procedures in obese patients are also increasing due to both treatment of obesity and other surgical problems of obese patients. Anesthesia-related complications are also seen in obese patients than in normal-weighted population. The importance of anesthetic applications in obese patients originates from physiological and pharmacokinetic alterations. Inhalation of these patients via mask or intubation during general anesthesia may be difficult or even impossible. Determination of extubation time after awakening from anesthesia is also a critical decision. Sleep apnea syndrome and postoperative atelectasis are more common in obese patients than in normal-weighted population. Another vital complication that should be emphasized is thromboembolism, whose incidence and severity may be decreased by pharmacological and functional preventive modalities. This patient population has elevated risk of perioperative mortality and morbidity. Prior to any elective surgical procedure, an obese patient should be thoroughly evaluated to check medical conditions that may increase perioperative mortality risk. Since anesthesiologists will gradually encounter more obese patients, they need a better comprehending of the difficulties of obesity during anesthetic procedures and taking more preventive measures for their patients to avoid complications, or rendering them less traumatic, if any.

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Morbid obesity and the prone position: a case report

Cited by 23 publications

References 12 publications

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

Sacrococcygeal local anaesthesia versus general anaesthesia for pilonidal sinus surgery: a prospective randomised trial

Obesity and Anesthesia Management

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Morbid obesity and the prone position: a case report

Cited by 23 publications

References 12 publications

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m2): overcoming the challenges

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m2): overcoming the challenges

Sacrococcygeal local anaesthesia versus general anaesthesia for pilonidal sinus surgery: a prospective randomised trial

Obesity and Anesthesia Management

Contact Info

Product

Resources

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Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges

Percutaneous nephrolithotomy in super obese patients (body mass index ≥ 50 kg/m²): overcoming the challenges