Perioperative management of the obese surgical patient

Lang, Laura; Parekh, Krishna N.; Tsui, B Y K; Maze, Mervyn

doi:10.1093/bmb/ldx041

Cited by 46 publications

(28 citation statements)

References 209 publications

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“…The median BMI in the complications group was 30 while the median BMI in the no complications group was 26. Obesity has been shown to worsen oxygenation through several mechanisms, including increased intraabdominal pressure and atelectasis [ 15 – 17 ]. Whether an isolated elevated BMI is a causal factor for complications during deep extubations will need further investigation.…”

Section: Discussionmentioning

confidence: 99%

Incidence of airway complications associated with deep extubation in adults

et al. 2020

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Background Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p < 0.05). Conclusions The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

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Section: Discussionmentioning

confidence: 99%

Incidence of airway complications associated with deep extubation in adults

et al. 2020

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“…The median BMI in the complications group was 30 while the median BMI in the no complications group was 26. Obesity has been shown to worsen oxygenation through several mechanisms, including increased intraabdominal pressure and atelectasis [16][17][18]. Whether an isolated elevated BMI is a causal factor for complications during deep extubations will need further investigation.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Airway Complications Associated with Deep Extubation in Adults

Juang

Cordoba

Ciaramella

et al. 2020

Preprint

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Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia. In the vast majority of cases, this is carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. This smooth emergence is particularly important for procedures that require maintenance of stable levels of intraocular and intracranial pressures, such as in neurologic, ophthalmic, and head-and-neck surgery [1]. Reluctance to performing deep extubation in adults, even in appropriate circumstances, is common and likely derives both from concerns for potential respiratory complications [2] and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was low and all easily reversible. And patient factors and extubation conditions may influence probability of success in deep extubation.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence of Airway Complications Associated with Deep Extubation in Adults

Juang

Cordoba

Ciaramella

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

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Perioperative management of the obese surgical patient

Cited by 46 publications

References 209 publications

Incidence of airway complications associated with deep extubation in adults

Incidence of airway complications associated with deep extubation in adults

Incidence of Airway Complications Associated with Deep Extubation in Adults

Incidence of Airway Complications Associated with Deep Extubation in Adults

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