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1.
Post-anesthesia Recovery after Infusion of Propofol with Remifentanil or Alfentanil or Fentanyl in Morbidly Obese Patients 总被引:2,自引:0,他引:2
Background: The type of opioid used during general anesthesia in the morbidly obese influences recovery and the postoperative
period. In a randomized clinical trial, the postoperative recovery profile and early period after general anesthesia with
remifentanil, fentanyl and alfentanil were compared in morbidly obese patients. Material and Method: 60 morbidly obese patients
with BMI >35 kg/m2 (mean 43.31) undergoing open Roux-en-y gastric bypass were randomly divided into 3 groups: remifentanil (R), fentanyl (F),
and alfentanil (A). Dosage of opioids was based on ideal body weight (IBW): fentanyl 5 mcg/kg for intubation followed by infusion
of 0.025-0.05 mcg/kg/min; alfentanil 15 mcg/kg initially, then 1.0-1.5 mcg kg/min; and remifentanil 1 mcg/kg followed by infusion
of 0.25-1.5 mcg/kg/min. Anesthesia was induced with infusion of propofol and oxygen with N2O (1:1). After anesthesia, the duration to response to verbal command, spontaneous respiration, adequate respiration, and
safe extubation were recorded.The incidence of postoperative nausea and vomiting were recorded. Using verbal scale for evaluation
of postoperative pain, the early postoperative analgesia requirements were assessed. Results: Demographic profiles and duration
of procedure did not differ between groups. A total dose of propofol was significantly lower in Group R compared with Groups
A and F (P <0.05). Duration to spontaneous respiration, adequate respiration and safe extubation were significantly shorter in Group
R compared with Group F (P <0.05). Shortly after anesthesia, significantly more patients in Group R required additional dose of analgesic than in Group
F (P <0.05). Postoperative nausea and vomiting (PONV) occurred significantly more often in Group R compared with Group F (P <0.05). Recovery profile of Group A was more similar to Group R, and postoperative pain and PONV evaluation more similar
to Group F. Conclusion: In morbidly obese individuals, alfentanil or fentanyl and remifentanil can be safely used, but there
is a higher rate of PONV and postoperative pain in the remifentanil group. 相似文献
2.
Background: Although the implications for the anesthetic and perioperative care of severely obese patients undergoing weight
loss operations are considerable, current anesthetic management of super-obese (SO) patients (BMI ≥50 kg/m2), including super-super-obese (BMI ≥60) derives from experience with morbidly obese (MO) patients (BMI 40-49.9 kg/m2). We compared anesthetic and perioperative data of SO patients and MO patients undergoing weight loss operations to evaluate
if anesthetic management influenced outcome. Methods: A retrospective analysis was performed on data from 150 consecutive
patients (119 MO, 31 SO) undergoing bariatric surgery between May 2000 and March 2005. Data analyzed included preoperative
anesthetic assessment, anesthetic management, postoperative care, and intra- or postoperative complications. Results: There
were no differences in anesthetic management or in postoperative course or outcome between MO and SO patients. Intraoperative
surgical complications occurred in 26% (n=8) in the SO group and 14% (n=15) in the MO group (P<0.01). Conclusions: No differences in outcome occurred between MO and SO patients undergoing bariatric operations under similar
anesthetic management. Anesthesia for weight loss surgery can be safely performed on SO patients with the understanding that
these patients are not at risk per se due to their higher BMI. The degree of obesity influenced only the incidence of intraoperative surgical complications. 相似文献
3.
Preoperative assessment of blood volume (BV) is important for patients undergoing surgery. The mean value for indexed blood
volume (InBV) in normal weight adults is 70 mL/kg. Since InBV decreases in a non-linear manner with increasing weight, this value cannot be used for obese and morbidly obese patients.
We present an equation that allows estimation of InBV over the entire range of body weights. 相似文献
4.
Fabris de Souza SA Faintuch J Valezi AC Sant'Anna AF Gama-Rodrigues JJ de Batista Fonseca IC de Melo RD 《Obesity surgery》2005,15(7):1013-1016
Background: Postural deviations in morbidly obese individuals may contribute to low self-esteem and to long-term adverse effects
on bones and joints. In a case-control study, the axial skeleton was investigated, to disclose the main abnormalities found
in obese compared to non-obese groups. Methods: 2 groups were compared. Group 1, severely obese patients (n= 32), age 41.5 ± 8.2 years, BMI 49.4 ± 6.6 kg/m2, 93.8% females, and group 2 non-obese (n= 30), age 43.5 ± 5.8 years, BMI 24.6 ± 5.1 kg/m2, 96.7% females, had their posture analyzed through clinical examination and radiological imaging. Variables measured were
anterior, lateral and posterior angular deviation from the vertical body axis at the head, shoulders, pelvis, Thales triangle,
spine, knees, ankles and feet. Data are shown as a percentage of abnormal angles in the 2 groups. Results: On anterior analysis
of the 2 groups, disturbances affected head (37.5% vs 13.3%), Thales angle (78.1% vs 53.3%), knees (84.4% vs 33.3%), legs
(59.4% vs 30.0%) and support base (59.4% vs 26.7%) (P<0.05). On posterior view, the spine was the deranged segment (87.5% vs 36.7%) (P<0.05), and on lateral assessment, 100% of the results were abnormal. Conclusions: 1) Individuals with morbid obesity present
important postural alterations. 2) Seriously altered posture was the rule for the obese population in this study, especially
in the spine, knees and feet. 3) Most patients had compatible clinical complaints, but they rarely associated the bone and
joint pain with the obesity and axial skeleton deviations. 4) Planned physical activity should be part of the treatment of
severe obesity, in order to correct deviations, prevent new ones, and improve quality of life. 相似文献
5.
Background: Surgery is the most effective therapeutic option for weight reduction in carefully selected patients with morbid
obesity resistant to conventional treatment. However, surgical treatment is not the solution but an important precondition
for successful management of morbid obesity. Methods: All patients undergo a psychiatric examination before laparoscopic gastric
banding. At the first examination we inform all patients about the various forms of psychological support offered before and
especially after gastric banding. Results: A majority of the obese individuals are interested in psychological support postoperatively,
but only a minority of this patient group (about onequarter) ultimately enlists psychological support on a regular or irregular
basis. Some specific psychological topics have proved to be particularly important such as change of self-esteem as a consequence
of weight loss, problems in adopting new eating behaviors and the risk for developing a new eating disordered behavior, and
problems involving adequate problem-solving. Conclusions: In many cases, some form of psychological support is necessary in
order to cope with the new postoperative demands and to find more adequate coping strategies for underlying psychological,
psychosocial and environmental problems. The different kinds of psychological support and psychotherapeutic treatment available
at Innsbruck University Hospital for obese patients after gastric banding are discussed here. 相似文献
6.
Background: We evaluated the medium term changes in insulin sensitivity in morbidly obese patients with and without metabolic syndrome before and after Roux-en-Y gastric bypass (RYGBP) with silastic ring (Capella-Fobi). Methods: A longitudinal,
clinical intervention study was conducted in 40 patients between 18 and 65 years old, with obesity class II and III (BMI ≥35-52
kg/m2), divided into 2 groups: no metabolic syndrome (NMS, n=21) and metabolic syndrome (MS, n=19). Anthropometric measurements,
biochemical tests and classification of MS according to the NCEP criteria, were performed pre-operatively and at 3 and 6 months
postoperatively. Results: In the preoperative period, 87% of the patients presented obesity class III (BMI 47±5 kg/m2) while 13% of the patients had obesity class II (37±2 kg/m2), and 19 patients (47.5%) presented MS. In the preoperative period, there were no differences among patients with MS and
NMS in relation to the anthropometrics and body composition measurements. However, triglyceridemia, glycemia and insulinemia
were higher in the MS group compared to the NMS group (P<0.05), although there was no difference in HOMA between the groups. HDL-cholesterol was lower in the MS group (p<0.05). In both postoperative study periods, all patients had significant reduction of anthropometric variables, body composition
and biochemical variables. There were no differences between MS and NMS (p>0.05) groups. However, insulinemia decreased more in the postoperative period in the MS group compared to the NMS group (p<0.05). MS frequency in the MS group diminished to 26% after 3 postoperative months and no patient presented features of MS
after 6 months postoperatively. Conclusions: Based on these observation: 1) patients of class II and III obesity present peripheral
resistance to hyperinsulinemia without hyperglycemia; 2) RYGBP is able to reduce anthropometric measurements and body composition
in a similar way for patients who have, or have not, MS; 3) there is rapid normalization of biochemistry of carbohydrates
and lipids; 4) patients with previous MS lose the criteria needed for this diagnosis after 6 postoperative months. 相似文献
7.
A safe protocol for conscious sedation and control during placement (or extraction) of an intragastric balloon in massively
obese patients is described. 相似文献
8.
Gastro-esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients 总被引:2,自引:2,他引:0
Background: Morbid obesity has long been considered as a contributing factor to gastro-esophageal reflux, but the literature
contains conflicting data on the subject. The authors studied a large number of morbidly obese candidates for bariatric surgery
with objective means, in order to better define the incidence of gastro-esophageal reflux disease (GERD) and esophageal motility
disorders in this population. Methods: Morbidly obese patients, in whom indication for bariatric surgery was confirmed after
complete evaluation, were included consecutively during a 4-year period. The evaluation included history of reflux symptoms,
upper GI endoscopy, 24-hour pH monitoring, and stationary esophageal manometry. Results: 345 patients were studied, of whom
35.8% reported reflux symptoms. Endoscopy showed a hiatus hernia in 181 patients (52.6%), and reflux esophagitis in 108 (31.4%).
24-hour pH monitoring revealed an elevated De Meester score in 163 patients (51.7%). Manometry was normal in 247 patients
(74.4%), and showed a decreased lower esophageal sphincter pressure in 59 (17.7%). Esophagitis and abnormal pH testing were
more common in patients with symptoms or hiatus hernia, and the incidence of esophagitis was higher with abnormal pH testing.
Esophagitis was associated with increased weight and abdominal obesity. Conclusions: This study confirms the increased prevalence
of GERD in the morbidly obese population. Upper GI endoscopy should be performed routinely during evaluation of morbidly obese
patients for bariatric surgery. When both conditions coexist, effective treatment is probably best provided by Roux-en-Y gastric
bypass, which produces effective weight loss and correction of pathological reflux. 相似文献
9.
Background: Obese individuals have been reported to have a heightened desire for and ability to identify sweets when compared
with leaner persons. Smell, like taste, may also be altered in obese persons compared with leaner subjects. This study was
designed to determine if the sense of smell is different between morbidly obese and moderately obese individuals. Methods:
101 adult volunteers undergoing preoperative evaluation completed the 12-item Cross-Cultural Smell Identification Test (CC-SIT)
before surgical intervention. Age, BMI, and smoking history were also obtained. Results: 101 subjects completed the preoperative
CC-SIT (87 female, 14 male). Mean age of the subjects was 40 ± 12 years. Mean BMI was 42.5 ± 12.5 kg/m2. 46 subjects (46%) had a BMI >45. 21 were smokers (21%). 9 subjects (9%), all female non-smokers, had a CC-SIT score representing
olfactory dysfunction. Subjects with BMI >45 were more likely to have olfactory dysfunction than subjects with BMI <45 (16%
vs 4%, P <0.05). Conclusion: Morbidly obese individuals are more likely than moderately obese individuals to demonstrate CC-SIT scores
consistent with olfactory dysfunction. The reason for this is unclear but is probably related to metabolic changes occurring
in morbidly obese individuals. 相似文献
10.
Background: Induction of pneumoperitoneum can be a difficult, time-consuming, and occasionally hazardous task in a morbidly
obese patient. Methods: We have induced pneumoperitoneum in 600 consecutive morbidly obese patients using a 120 mm Veress
needle inserted <1 mm beneath the left costal margin, between the mid-clavicular and anterior axillary lines. Absolute muscular
relaxation was necessary. Results: A distinct "pop" was felt on entering the peritoneal cavity. The expected intraperitoneal
pressure was 7-14 mmHg. A pressure >20 mmHg indicated that the Veress needle was in the abdominal wall. CO2 infusion began
at a flow of <1 L/min. "Shaking" the Veress needle to-and-fro improved flow to 1-2 L/min. Complete filling of the abdomen
occurred at 4.0 L or more at a pressure limit of 15 mmHg. Increasing the pressure limit to 17 mmHg did not change the rate
or final volume of CO2 infusion. After initial trocar placement, the Veress needle was observed. Frequently it was in the omentum and there was
CO2 beneath the omentum. There was one visceral injury in the 600 patients - a puncture wound to the muscularis, but not the
lumen, of the transverse colon. It was repaired laparoscopically with a single stitch. There have been no episodes of perforation
of a hollow viscus, no unusual bleeding from the abdominal wall or viscera, and no injuries to the liver or spleen. Conclusion:
Percutaneous induction of a pneumoperitoneum with the Veress needle in the left upper quadrant is a safe and effective technique
in morbidly obese patients. 相似文献
11.
Results of Laparoscopic Sleeve Gastrectomy (LSG) at 1 Year in Morbidly Obese Korean Patients 总被引:5,自引:1,他引:5
Background: In Asia, the type and main cause of obesity is different than in western society. Therefore, the treatment plan
should be differentiated, and the surgery for morbid obesity should be carefully chosen. The early results of laparoscopic
sleeve gastrectomy (LSG) without duodenal switch that has been performed in the Korean population is reported. Methods: We
retrospectively reviewed 130 patients who underwent LSG from January 2003 to May 2004. 60 of these patients now had >1 year
of regular follow-up, and are the subject of this report. LSG was performed through 4 12-mm ports and 1 15-mm port, using
the Endo-GIA stapler to create a lesser curve gastric tube over a 48-Fr bougie. Results: For the 60 patients, the postoperative
EWL was 71.6±21.9% at 6 months and 83.3±28.3% at 12 months. At 12 months after LSG, decrease in BMI was 9.2±3.7 kg/m2, and median weight loss was 24.6±10.0 kg. Dyslipidemia resolved in 75% of patients within 12 months. Diabetes resolved in
100% of patients within 6 months of operation. Hypertension resolved in 92.9% and improved in 100%. Joint pain resolved in
100% within 12 months. Weight loss plateaued at 12 months in the majority of patients. One patient has undergone a malabsorption
procedure (duodenal switch) as a second-stage operation. Conclusion: Additional studies and follow-up are needed to determine
the best surgical treatment for morbidly obese Asian patients. However, LSG without the second-stage duodenal switch operation
has been an effective weight loss operation thus far, in most of the Korean patients. 相似文献
12.
Histological Behavior of Hepatic Steatosis in Morbidly Obese Patients after Weight Loss Induced by Bariatric Surgery 总被引:3,自引:0,他引:3
Mottin CC Moretto M Padoin AV Kupski C Swarowsky AM Glock L Duval V da Silva JB 《Obesity surgery》2005,15(6):788-793
Background: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation to steatohepatitis and cirrhosis
has been extensively studied among these patients. The aim of this study was to evaluate the behavior of hepatic steatosis
with weight loss 1 year after bariatric surgery. Methods: This study is a historical cohort that compared liver biopsies obtained
from morbidly obese patients during the bariatric operation, with percutaneous biopsies taken from the same patient 1 year
after surgery. The results were compared with weight loss, patients' profile (gender, age, body mass index (BMI) and waist/hip
ratio), and with the presence of co-morbidities such as diabetes, hypertension, and dyslipidemia. Results: 90 patients who
had liver biopsies taken at the operation and postoperative period for bariatric surgery were included. The prevalence of
hepatic steatosis was 87.6%. The average percent of excess weight loss was 81.4%. On the second biopsy, 16 patients (17.8%)
of the total had the same degree of steatosis, 25 (27.8%) improved their steatosis pattern and 49 (54.4%) had normal hepatic
tissue. There was no statistical difference regarding age, BMI, waist/hip ratio, and co-morbidities (P>0.05), but there was a difference in gender (P=0.044). Conclusion: Significant improvement in the hepatic histology of steatosis was observed after weight loss induced
by bariatric surgery in most patients. There was no patient with a worsening in the histology. 相似文献
13.
Background: Bariatric surgery has often been avoided in patients with known cardiac disease because of the risks inherent
in this patient population. This study was done to evaluate both the risks and benefits of Roux-en-Y gastric bypass (RYGBP)
in morbidly obese patients with established cardiac disease. Methods: Data were analyzed to compare preoperative with postoperative
co-morbid cardiac risk factors, peri-operative and postoperative complications, and change in body mass index (BMI) in 77
consecutive patients who had a preoperative diagnosis of cardiac disease and underwent RYGBP between March 1998 and January
31, 2006. Findings were compared to a concomitant control group without cardiac disease. Results: The preoperative presence
of cardiac disease was manifested primarily as coronary artery disease (CAD) (45 patients) or as congestive heart failure
(CHF) (32 patients). Of the patients with CAD, 60% had diabetes, 91% had hypertension and 39% had hyperlipidemia. 58% had
one or more prior invasive cardiac procedures. In the CHF group, 50% had diabetes, 71% had hypertension and 44% had hyperlipidemia.
The average length of stay was 3.7 days for CAD patients and 3.3 days for CHF compared to 3.0 days for controls. All co-morbid
conditions were improved, and no patient died from cardiac disease. However, one patient died as a complication of GI bleeding,
one patient subsequently underwent revascularization and another underwent stenting. Other complications up to 5 years postoperatively
were frequent but seldom life-threatening. Conclusion: RYGBP surgery in patients with existing cardiac disease appears to
have acceptable risk and is effective in reducing the co-morbid conditions of diabetes, hypertension, hyperlipidemia, sleep
apnea and arthritis, but longer term data are needed. 相似文献
14.
A Preliminary Study of the Optimal Anesthesia Positioning for the Morbidly Obese Patient 总被引:4,自引:0,他引:4
Background: Hypoxemia during the induction of general anesthesia for the morbidly obese patient is a major concern of anesthesiologists.
The etiology of this pathophysiological problem is multifactorial, and patient positioning may be a contributing factor. The
present study was designed to identify optimal patient positioning for the induction of general anesthesia that minimizes
the risk of hypoxemia in these patients. Methods: 26 morbidly obese patients (body mass index - BMI 56±3) were randomly assigned
to one of three positions for induction of anesthesia: 1) 30° Reverse Trendelenburg; 2) Supine-Horizontal; 3) 30° Back Up
Fowler. Mask ventilation, full neuromuscular paralysis and direct laryngoscopy were performed. Any airway difficulties were
noted. After endotracheal tube placement, subjects were ventilated for 5 minutes with 1% isoflurane in a mixture of 50% oxygen
/ 50% air and then disconnected from the ventilation circuit.The time required for capillary oxygen saturation (SaO2), as measured by pulse oximeter, to decline from 100% to 92% was noted and identified as the safe apnea period (SAP). Ventilation
was then immediately re-established.The lowest SaO2 after resuming ventilation and the time from that nadir to an SaO2 of 97% were also recorded. Results: BMI and hip-waist ratios of patients in groups 1, 2 and 3 did not significantly differ.
There were no differences in airway difficulties between the different groups. The SAP in groups 1, 2 and 3 was 178±55, 123±24
and 153±63 seconds, respectively. The SaO2 of patients in the reverse Trendelenburg position dropped the least and took the shortest time to recover to 97%. Conclusions:
In morbidly obese patients, the 30° Reverse Trendelenburg position provided the longest SAP when compared to the 30° Back
Up Fowler and Horizontal-Supine positions. Since on induction of general anesthesia morbidly obese patients may be difficult
to mask ventilate and/or intubate, this extra time may preclude adverse sequelae resulting from hypoxemia. Therefore, Reverse
Trendelenburg is recommended as the optimal position for induction. 相似文献
15.
Alvarez AO Cascardo A Albarracin Menendez S Capria JJ Cordero RA 《Obesity surgery》2000,10(4):353-360
Background: According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must
be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned,
in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery.The ideal
anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and
rapid emergence from anesthesia.To approach these ideal conditions,aTotal Intravenous Anesthesia (TIVA) with midazolam, remifentanil,
propofol and cisatracurium was designed and analyzed. Methods: 10 consenting morbidly obese patients scheduled for elective
Laparoscopic Adjustable Gastric Banding participated in the study.TIVA with midazolam, remifentanil, propofol and cisatracurium
was used in all cases.Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications,
incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated. Results:The
analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance
with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional
efficiency. Conclusions: TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure,
predictable and economic for the anesthetic management of morbidly obese patients. 相似文献
16.
Busetto L Segato G De Luca M De Marchi F Foletto M Vianello M Valeri M Favretti F Enzi G 《Obesity surgery》2005,15(2):195-201
Background: The authors investigated the outcome of morbidly obese patients with binge eating disorder (BED) treated surgically
with laparoscopic adjustable gastric banding. Methods: The 5-year outcomes of 130 patients with BED and 249 patients without
BED are described. The diagnosis of BED was made preoperatively and all patients with BED were supported with psychological
therapy. Results: Patients with and without BED had similar BMI levels before surgery. More patients with than without BED had depressive symptoms and associated minor
disturbances of eating behavior (night eating and grazing). Percent excess weight loss (%EWL) in the first 5 years after surgery
was similar in patients with and without BED. The percentage of BED patients showing %EWL >50% at the 5-year evaluation was
23.1, and 25.7% in non-BED patients. The percentage of patients showing weight regain in the last 4 years of follow-up was
similar in binge eaters (20.8%) and in non-binge eaters (22.5%). The 5-year frequency of gastric pouch and esophageal dilatation
was significantly higher in binge eaters than in non-binge eaters (25.4 vs 17.7 %, P<0.05 and 10.0 vs 4.8%, P<0.05, respectively). Binge eaters underwent a higher number of postoperative band adjustments than
non-binge eaters (3.0±2.1 vs 2.6±1.9, P<0.05) and the maximum band fill after surgery was higher in the BED patients than in non-BED patients (3.2±1.2 vs 2.8±1.3
ml, P<0.01). Conclusion: Morbidly obese patients with BED supported by adequate psychological treatment can have good outcomes
after gastric banding. 相似文献
17.
Gallstone Formation after Weight Loss following Gastric Banding in Morbidly Obese Dutch Patients 总被引:2,自引:0,他引:2
Background: Obesity is a risk factor for the development of gallstones. Rapid weight loss may be an even stronger risk factor.
We retrospectively assessed the prevalence and risk factors of gallstone formation after adjustable gastric banding (AGB)
in a Dutch population. Methods: All patients who underwent AGB between Jan 1992 and Dec 2000 for morbid obesity were invited
to take part in this study. Transabdominal ultrasonography of the gallbladder was performed in those patients without a prior
history of cholecystectomy (Group A). Additionally, 45 morbidly obese patients underwent ultrasonography of the gallbladder
before weight reduction surgery (Group B). Results: 120 patients were enrolled in the study (Group A). Prior history of cholecystectomy
was present in 21 patients: 16 before and 5 after AGB. Ultrasonography was performed in 98 patients: gallstones were present
in 26 (26.5%). On multivariate analysis, neither preoperative weight, nor maximum weight loss, nor the interval between operation
and the postoperative ultrasonography were determinants of the risk for developing gallstone disease. Prevalence of gallstones
was significantly lower in the morbidly obese patients who had not yet undergone weight reduction surgery (Group B). Conclusions:
Rapid weight loss induced by AGB, is an important risk factor for the development of gallstones. No additional determinants
were found. Every morbidly obese patient undergoing bariatric surgery must be considered at risk for developing gallstone
disease. 相似文献
18.
Background: Morbidly obese patients with urolithiasis present a therapeutic and diagnostic challenge to the Urologist. Management is
reported and potential difficulties discussed. Methods: Morbidly obese patients (body mass index ≥ 40kg/m2) with stone disease were identified by retrospective review. Stone load
was calculated and treatment modalities noted. Results: 18 renal units (kidneys) were treated in 17 patients. Of these, 2 required no treatment, 2 had open procedures, and 15 were
treated with flexible ureteroscopy. Mean stone burden in patients treated with flexible ureteroscopy was 18 mm, but 8 patients
had stone loads >15 mm and in these patients mean stone burden was 23 mm. All were successfully treated or rendered asymptomatic.
There were no major complications. Conclusion: Obesity is increasingly prevalent and associated with a high incidence of co-morbidity and complications. Imaging can be
difficult and treatment options are limited. Flexible ureteroscopy has proven to be the most successful treatment option,
and can avoid the need for more invasive procedures. Furthermore, stone loads greater than normally acceptable can be successfully
undertaken in these patients, and should be attempted due to problems associated with other techniques. 相似文献
19.
Background: Recent data suggests that increased intra-abdominal pressure (IAP) is one factor associated with the morbidity
of morbidly obese patients, who have a BMI >35 kg/m2. IAP has been proposed to be an abdominal compartment syndrome (ACS). This study investigated the characteristics of IAP
in morbidly obese patients. Methods: 45 morbidly obese patients (mean BMI 55±2 kg/m2) had IAP measured using urinary bladder pressure. Results: The mean IAP for the morbidly obese group was 12±0.8 cmH2O, increased when compared to controls (IAP=0±2 cmH2O). The IAP correlated to the sagittal abdominal diameter, an index of the degree of central obesity (r=+0.83, P<0.02); however, it did not correlate to basal insulin, body weight, or BMI. The end-expiratory IAP did not change when measured
after the laparotomy incision was made, but IAP measured in the last 15 patients increased during the first 2 postoperative
days. The IAP for patients with pressure-related morbidity (gastroesophageal reflux disease, hernia, stress incontinence,
diabetes, hypertension, and venous insufficiency) was 12±1 cmH2O, while those without these morbidities had an IAP of 9±0.8 cmH2O. Conclusion: We conclude that IAP is increased in morbid obesity. This increased IAP is a function of central obesity and
is associated with increased morbidity. The degree of IAP elevation correlates with increased co-morbidities. We also conclude
that elevation in IAP in morbid obesity is not a true ACS but represents a direct mass effect of the visceral obesity. 相似文献
20.
Background: Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists.
BIS monitoring is useful in providing fast recovery. Methods: We describe the anesthetic management of 23 morbidly obese patients
who underwent elective open Roux-en-Y gastric bypass (RYGBP) for morbid obesity. Thoracic epidural analgesia combined with
light general anesthesia with propofol and nitrous oxide adjusted to keep the bispectral index (BIS) around 60 was performed.
Intraoperative hemodynamic stability, early and intermediate recovery and patient satisfaction were assessed. Results: The
cardiovascular variables were fairly stable during surgery. Times to spontaneous respiration, response to orders, tube removal
and orientation were 4 ± 3, 6 ± 2, 8 ± 3, and 13 ± 7 respectively. Times until the patients were able to sit unassisted, stand
unassisted and walk freely without assistance were 319 ± 25, 803 ± 78, 1070 ± 75 respectively (values expressed as min, mean
± sd). Conclusion: Propofol-nitrous oxide anesthesia adjusted to keep BIS around 60, combined with thoracic epidural analgesia,
seems to be effective in providing predictable and uneventful recovery to patients submitted to elective RYGBP. 相似文献