Perioperative management of the severely obese patient: a selective pathophysiological review

Cullen, Aidan; Ferguson, Andrew

doi:10.1007/s12630-012-9760-2

Cited by 78 publications

(60 citation statements)

References 146 publications

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“…A 54-yr-old morbidly obese woman (weight, 97 kg; height, 152 cm; body mass index, 42 kgÁm -2 ) is scheduled for 2 . La masse corporelle totale et la distribution régionale du tissu adipeux en excès influencent le risque qu'une personne court de souffrir des nombreuses comorbidités associées à l'obésité.…”

Section: Clinical Caseunclassified

“…L'évaluation préopératoire joue donc un rôle crucial pour identifier de telles comorbidités et permet d'optimiser la prise en charge médicale, le cas échéant, ainsi que de planifier le déroulement de la période périopératoire afin de minimiser la morbidité et la mortalité. 2 Ce module de développement professionnel continu traite principalement de la prise en charge des voies aériennes et de l'oxygénation du patient obèse subissant une anesthésie générale.…”

Section: Clinical Caseunclassified

“…Preoperative assessment therefore plays an important role in identifying such coexisting conditions, optimizing medical management where possible, and planning the perioperative course to minimize morbidity and mortality. 2 This Continuing Professional Development module focuses on airway management and oxygenation in the obese patient undergoing general anesthesia.…”

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confidence: 99%

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Airway management and oxygenation in obese patients

Murphy

Wong

2013

Can J Anesth/J Can Anesth

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Section: Clinical Caseunclassified

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confidence: 99%

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Airway management and oxygenation in obese patients

Murphy

Wong

2013

Can J Anesth/J Can Anesth

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“…Obesity is a proinflammatory disorder with the potential to modulate nociception via multiple tissue systems [9]. Adipocytes secrete leptin, a proinflammatory cytokine that also functions to signal satiety [3].…”

Section: Introductionmentioning

confidence: 99%

Leptin status alters buprenorphine-induced antinociception in obese mice with dysfunctional leptin receptors

Glovak

Mihalko

Baghdoyan

et al. 2017

Neuroscience Letters

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Buprenorphine is an opiate used for pain management and to treat opiate addiction. The cytokine leptin can modulate nociception, but the extent to which buprenorphine-induced antinociception varies as a function of leptin signaling has not been characterized. Four congenic mouse lines with phenotypes that include differences in body weight and leptin status were used to test the hypothesis that the antinociceptive effects of buprenorphine vary as function of sex and leptin signaling. Each mouse line was comprised of males (n=12) and females (n=12) for a total of 96 animals. Groups included C57BL/6J (B6) mice (wild type), B6 mice with diet-induced obesity (DIO), obese B6.Cg-Lepob/J (ob/ob) mice lacking leptin, and obese B6.BKS(D)-Leprdb/J (db/db) mice with dysfunctional leptin receptors. The dependent measure was tail flick latency (TFL) in seconds for mouse-initiated tail removal from a warm water bath. Independent variables were intraperitoneal administration of saline (control) or buprenorphine (0.3 mg/kg). Within every mouse line, buprenorphine significantly increased TFL relative to saline. Compared to the other mouse lines, db/db mice with dysfunctional leptin receptors had a significantly longer TFL after saline and after buprenorphine. TFL did not vary significantly by body weight or sex. The results provide novel support for the interpretation that acute thermal nociception is associated with altered leptin signaling.

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“…Se ha sugerido que las dosis de rocuronio en obesos sean calculadas en base al peso ideal 7,8,11,14,16 pero esta recomendación está basada más bien en la prudencia que en la evidencia científica 17 . Por esta razón, se decidió diseñar un estudio con el objetivo de comparar el comportamiento del rocuronio al administrarlo en base a peso real (TBW) y a peso ideal (IBW) en pacientes obesos.…”

Section: Introductionunclassified

Rocuronio en obesos: ¿Debe dosificarse por peso real o peso ideal?

Ojeda¹,

Gazabatt²,

Bustamante³

et al. 2014

Rev Chil Anest

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resumenEl aumento universal en la prevalencia de obesidad ha causado que los anestesiólogos se vean frecuentemente enfrentados a anestesiar pacientes obesos. Pese a esto aún existen dudas respecto a cómo dosificar las drogas en estos pacientes. La literatura recomienda dosificar el rocuronio en obesos en base al peso ideal (IBW, iniciales del inglés Ideal Body Weight) pero esta sugerencia está basada más bien en la prudencia que en la evidencia. Se decidió explorar con análisis de sobrevida (análisis tiempo-evento), la duración del rocuronio en obesos al ser dosificado por peso ideal (IBW) y por peso real (TBW, iniciales del inglés de peso corporal total). Al administrar el rocuronio en base al peso real (TBW) se observó una prolongación en su duración de acción con un acortamiento de su latencia en relación con la dosificación en base al peso ideal (IBW). Hubo una marcada prolongación de la duración de acción y el índice de recuperación tanto al dosificar por peso real como peso ideal. Debido a esta sensibilidad aumentada al rocuronio en pacientes obesos recomendamos dosificarlo en base al peso ideal, excepto si se necesita intubar rápidamente. AbstractThe universal increase in prevalence of obesity has caused that anesthesiologist are frequently encountered with anesthetizing obese patients. There stills exists doubt on how to dosage drugs to these patients. Literature recommends dosing rocuronium in the obese based on ideal weight (IBW), being this suggestion based more on prudence than on evidence. Randomized control trial was designed for obese patients scheduled for bariatric surgery to study the pharmacodynamics of rocuronium in this population. Patients were randomly assigned into two groups: rocuronium dosage 0.6 mg·kg -1 for real weight (TBW) or rocuronium dosage of 0.6 mg·kg -1 for ideal weight (IBW). Ideal weight was calculated according to Lemmens formula. The reference group was the dosage based on IBW. Previous calibration, evaluating the first twitch of train-of-four (T 1 ), we registered onset time, clinical duration, recovery index, level of muscle relaxation to which the first reinforcement was administered and clinical duration of rocuronium reinforcement. A total of 100 patients were part of the study: 54 in group TBW and 46 in group IBW. When administering rocuronium based on real weight (TBW) a prolongation in clinical duration was found: Medium (IQR*); 79.5 (67 -105) minutes versus 44.5 (33 -63.5 minutes) in the IBW group (p < 0.001) with a decrease in latency in the TBW group 120 (90-150 secs.) versus the IBW group 180 (120 -270 secs.) (p < 0.001). There were no differences in the recovery index between both levels of dosing. There was a marked prolongation of both clinical duration and recovery index in both groups, as supported in some literature. Based on the evidence, we recommend to dose rocuronium in obese patients based on ideal weight, with the exception of cases were quick intubation is required.* IQR = interquartile range.

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Perioperative management of the severely obese patient: a selective pathophysiological review

Cited by 78 publications

References 146 publications

Airway management and oxygenation in obese patients

Airway management and oxygenation in obese patients

Leptin status alters buprenorphine-induced antinociception in obese mice with dysfunctional leptin receptors

Rocuronio en obesos: ¿Debe dosificarse por peso real o peso ideal?

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