Impactos de la súper obesidad versus la obesidad mórbida sobre la mecánica respiratoria y los parámetros hemodinámicos simples durante la cirugía bariátrica
The Impacts of Super Obesity Versus Morbid Obesity on Respiratory Mechanics and Simple Hemodynamic Parameters During Bariatric Surgery.
Salihoglu T, Salihoglu Z, Zengin AK, Taskin M, Colakoglu N, Babazade R.
Department of Anesthesiology and Reanimation, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey, tsalihoglu@hotmail.com.
Obes Surg. 2012 Oct 3. [Epub ahead of print]
Abstract
BACKGROUND: This study was designed to determine the impact of the degree of obesity on respiratory mechanics and simple hemodynamic parameters at laparoscopic bariatric surgery. METHODS: The patients were divided into two groups, each of which included 24 patients (a morbidly obese group and a super obese group) undergoing laparoscopic bariatric surgery. Dynamic respiratory compliance, respiratory resistance, and peak inspiratory pressures were measured at four time points: 10 min after anesthesia induction (T1: induction), 10 min after pneumoperitoneum (T2: pneumoperitoneum), 10 min after terminating pneumoperitoneum (T3: end-pneumoperitoneum), and before extubation (T4: extubation). The systolic, diastolic, and mean arterial pressures and the heart rate values were measured noninvasively in T0 (10 min before operation). RESULTS: Obesity was found to cause a statistically significant increase in respiratory resistance and a peak inspiratory pressure and a decrease in dynamic respiratory compliance. In the morbidly obese group, the lowest dynamic respiratory compliance was 37mL/cm H(2)O, but it was 33mL/cm H(2)O in the super obese group. The systolic pressure, diastolic pressure, and mean arterial pressure were found to decrease significantly in both groups. CONCLUSIONS: Morbid obesity and super obesity have negative effects on hemodynamics and respiratory mechanics.
http://www.springerlink.com/content/uq123946442l8103/fulltext.pdf
Efectos del neumoperitoneo sobre la mecánica respiratoria durante cirugía bariátrica
The Effects of Pneumoperitoneum on Respiratory Mechanics During Bariatric Surgery
Sener Demiroluk, MD1; Ziya Salihoglu, MD1; Kagan Zengin, MD2; Yildiz
Kose, MD1; Mustafa Taskin, MD2
University of Istanbul, Cerrahpasa Medical School, Department of 1Anaesthesiology and 2General Surgery, Istanbul, Turkey
Obesity Surgery, 12, 376-379
Background: The aim of this study was to investigate the influence of laparoscopic and conventional open surgery on respiratory mechanics, and blood gases, and to determine convenient techniques from the point of view of intraoperative respiratory mechanics, for bariatric surgery. Method: 40 morbidly obese patients were divided into 2 groups, patients undergoing laparoscopy Group 1, and patients undergoing conventional open surgery Group 2. Resistance of airway, dynamic compliance, and peak inspiratory pressure were measured. Measurement was performed in 4 periods: a) after anesthesia induction, b) after pneumoperitoneum in the Group 1 and after incision in the Group 2, c) after gastric band placement, d) and 5 min before extubation. Blood gases were recorded concomitantly. Results: There was no significant difference between the 2 groups in values of blood gases and respiratory mechanics. Conclusion: In the morbidly obese, laparoscopic and open surgery did not cause a significant difference for respiratory mechanics when compared with each other.
Key words: Morbid obesity, laparotomy, pneumoperitoneum, respiratory mechanics, compliance, bariatric
surgery
http://www.springerlink.com/content/l46m466075335353/fulltext.pdf
Desafíos en la evaluación del riesgo pulmonar y el manejo perioperatorio en pacientes sometidos a cirugía bariátrica
Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, Jaber W, Schauer P, Sessler D.
Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA. Kawr@ccf.org
Obes Surg. 2008 Jan;18(1):134-8. Epub 2007 Nov 16.
Abstract
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.
ttp://www.springerlink.com/content/u333063w537375kj/fulltext.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
The Impacts of Super Obesity Versus Morbid Obesity on Respiratory Mechanics and Simple Hemodynamic Parameters During Bariatric Surgery.
Salihoglu T, Salihoglu Z, Zengin AK, Taskin M, Colakoglu N, Babazade R.
Department of Anesthesiology and Reanimation, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey, tsalihoglu@hotmail.com.
Obes Surg. 2012 Oct 3. [Epub ahead of print]
Abstract
BACKGROUND: This study was designed to determine the impact of the degree of obesity on respiratory mechanics and simple hemodynamic parameters at laparoscopic bariatric surgery. METHODS: The patients were divided into two groups, each of which included 24 patients (a morbidly obese group and a super obese group) undergoing laparoscopic bariatric surgery. Dynamic respiratory compliance, respiratory resistance, and peak inspiratory pressures were measured at four time points: 10 min after anesthesia induction (T1: induction), 10 min after pneumoperitoneum (T2: pneumoperitoneum), 10 min after terminating pneumoperitoneum (T3: end-pneumoperitoneum), and before extubation (T4: extubation). The systolic, diastolic, and mean arterial pressures and the heart rate values were measured noninvasively in T0 (10 min before operation). RESULTS: Obesity was found to cause a statistically significant increase in respiratory resistance and a peak inspiratory pressure and a decrease in dynamic respiratory compliance. In the morbidly obese group, the lowest dynamic respiratory compliance was 37mL/cm H(2)O, but it was 33mL/cm H(2)O in the super obese group. The systolic pressure, diastolic pressure, and mean arterial pressure were found to decrease significantly in both groups. CONCLUSIONS: Morbid obesity and super obesity have negative effects on hemodynamics and respiratory mechanics.
http://www.springerlink.com/content/uq123946442l8103/fulltext.pdf
Efectos del neumoperitoneo sobre la mecánica respiratoria durante cirugía bariátrica
The Effects of Pneumoperitoneum on Respiratory Mechanics During Bariatric Surgery
Sener Demiroluk, MD1; Ziya Salihoglu, MD1; Kagan Zengin, MD2; Yildiz
Kose, MD1; Mustafa Taskin, MD2
University of Istanbul, Cerrahpasa Medical School, Department of 1Anaesthesiology and 2General Surgery, Istanbul, Turkey
Obesity Surgery, 12, 376-379
Background: The aim of this study was to investigate the influence of laparoscopic and conventional open surgery on respiratory mechanics, and blood gases, and to determine convenient techniques from the point of view of intraoperative respiratory mechanics, for bariatric surgery. Method: 40 morbidly obese patients were divided into 2 groups, patients undergoing laparoscopy Group 1, and patients undergoing conventional open surgery Group 2. Resistance of airway, dynamic compliance, and peak inspiratory pressure were measured. Measurement was performed in 4 periods: a) after anesthesia induction, b) after pneumoperitoneum in the Group 1 and after incision in the Group 2, c) after gastric band placement, d) and 5 min before extubation. Blood gases were recorded concomitantly. Results: There was no significant difference between the 2 groups in values of blood gases and respiratory mechanics. Conclusion: In the morbidly obese, laparoscopic and open surgery did not cause a significant difference for respiratory mechanics when compared with each other.
Key words: Morbid obesity, laparotomy, pneumoperitoneum, respiratory mechanics, compliance, bariatric
surgery
http://www.springerlink.com/content/l46m466075335353/fulltext.pdf
Desafíos en la evaluación del riesgo pulmonar y el manejo perioperatorio en pacientes sometidos a cirugía bariátrica
Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients.
Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, Jaber W, Schauer P, Sessler D.
Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA. Kawr@ccf.org
Obes Surg. 2008 Jan;18(1):134-8. Epub 2007 Nov 16.
Abstract
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.
ttp://www.springerlink.com/content/u333063w537375kj/fulltext.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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