Peri-operative management of the obese surgical patient 2015

Nightingale, Claire; Margarson, M.; Shearer, E.S.; Redman, J. W.; Lucas, D.N.; Cousins, Jonathan; Fox, W. T. A.; Kennedy, N.; Venn, P.J.H.; Skues, Mark A.; Gabbott, D. A.; Misra, U. C.; Pandit, J. J.; Popat, M.; Griffiths, R.

doi:10.1111/anae.13101

Cited by 238 publications

(82 citation statements)

References 115 publications

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“…High dose group = 4 mg.kg À1 ; middle dose group = 2 mg.kg À1 ; low dose group = 1 mg.kg À1 of sugammadex based on IBW. *Based on the AAGBI obesity guidelines [8]. The formulae for calculating LBW and ABW are those of Janmahasatian et al [18] and Gepts [19], respectively.…”

Section: Resultsmentioning

confidence: 99%

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Appropriate dosing of sugammadex to reverse deep rocuronium-induced neuromuscular blockade in morbidly obese patients

et al. 2015

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SummaryIn morbidly obese patients, the speed of reversal of neuromuscular blockade with sugammadex based on ideal body weight is still matter of debate. In this single-center, randomised, double-blinded study, neuromuscular blockade was monitored in 50 patients using acceleromyography at the adductor pollicis. At the end of surgery with deep rocuronium-induced neuromuscular blockade, patients randomly received sugammadex 4 mg.kg À1 (high dose group), 2 mg.kg À1 (middle dose group), or 1 mg.kg À1 (low dose group) of ideal body weight. After administration of the first dose of sugammadex, the mean (SD) recovery time (censored at 600 s) from deep neuromuscular blockade was significantly shorter (p < 0.001) in the high-dose group (n = 14; 255 (63) s) vs the middle-dose group (n = 13; 429 (102) s), or low-dose group (n = 4; 581 (154) s). Success rate from neuromuscular blockade reversal defined by a train-of-four ≥ 0.9 within 10 min after sugammadex administration, were 93%, 77% and 22% for these high, middle and low-dose groups respectively (p < 0.05 vs low-dose group). In morbidly obese patients, 4 mg.kg À1 of ideal body weight of sugammadex allows suitable reversal of deep rocuronium-induced neuromuscular blockade. Monitoring remains essential to detect residual curarisation or recurarisation.

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Section: Resultsmentioning

confidence: 99%

“…Therefore, its dosage in morbidly obese patients should be based on weight lower than TBW [8]. Studies that have examined the reversal process using sugammadex in morbidly obese patients concluded that usual doses calculated from ideal body weight (IBW) are insufficient [9,10].…”

Section: Introductionmentioning

confidence: 99%

Appropriate dosing of sugammadex to reverse deep rocuronium-induced neuromuscular blockade in morbidly obese patients

et al. 2015

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“…Most of these investigations have evaluated primary outcomes during and after anesthesia[ 115 , 116 ]. Although efforts have been made to develop standardized guidelines or protocols for the anesthetic care of the obese patient[ 117 ], there is no known ideal anesthesia technique or drug combination. However, the introduction of enhanced recovery after surgery (ERAS) protocols after obesity-related and bariatric procedures has gained great acceptance[ 118 , 119 ].…”

Section: Immunomodulatory Effects Of Anesthetics In Obesitymentioning

confidence: 99%

Immunomodulatory effects of anesthetics in obese patients

Heil

Silva

Pelosi

2017

WJCCM

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Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells (such as monocytes, neutrophils, and specific tissue macrophages) with release of pro- or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.

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“…Obese patients represent a diagnostic challenge for the surgeon, and require additional surgical preparation and time to assess anaesthetic and operative risks . Bariatric equipment and supplementary staff may also be necessary …”

Section: Introductionmentioning

confidence: 99%

Impact of body mass index on utilization of selected hospital resources for four common surgical procedures

Freckelton

Lambert

Smith

et al. 2019

ANZ Journal of Surgery

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Background Evidence about the impact of obesity on surgical resource consumption in the Australian setting is equivocal. Our objectives were to quantify the prevalence of obesity in four frequently performed surgical procedures and explore the association between body mass index (BMI) and hospital resource utilization including procedural duration, length of stay (LOS) and costs. Methods A retrospective cohort study of patients undergoing four surgical procedures at a tertiary referral centre in New South Wales, between 1 January 2016 and 31 December 2016, was conducted. The four surgical procedures were total hip replacement, laparoscopic appendectomy, laparoscopic cholecystectomy and hysteroscopy with dilatation and curettage. Surgical groups were stratified according to BMI category. Results A total of 699 patients were included in the study. The prevalence of obesity was significantly higher than local and national population estimates for all procedures except appendectomy. BMI was not associated with increased hospital resource utilization (procedural, anaesthetic or intensive care stay duration) in any of the four surgical procedures examined after controlling for age, gender and complexity. For other outcomes of hospital resource utilization (LOS and cost), the relationship was inconsistent across the four procedures examined. A high BMI was positively associated with higher LOS, medical costs and allied health costs in those who underwent an appendectomy, and critical care costs in those who underwent laparoscopic cholecystectomy. Conclusion Obesity was common in patients undergoing four frequently performed surgical procedures. The relationship between BMI and hospital resource utilization appears to be complex and varies across the four procedures examined.

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Peri-operative management of the obese surgical patient 2015

Cited by 238 publications

References 115 publications

Appropriate dosing of sugammadex to reverse deep rocuronium-induced neuromuscular blockade in morbidly obese patients

Appropriate dosing of sugammadex to reverse deep rocuronium-induced neuromuscular blockade in morbidly obese patients

Immunomodulatory effects of anesthetics in obese patients

Impact of body mass index on utilization of selected hospital resources for four common surgical procedures

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