jueves, 4 de agosto de 2016

Obesidad / Obesity

Agosto 3, 2016. No. 2406

Obesidad. Cambios fisiológicos y sus implicaciones en el manejo preoperatorio
Obesity: physiologic changes and implications for preoperative management.
BMC Anesthesiol. 2015 Jul 4;15:97. doi: 10.1186/s12871-015-0079-8.
The proportion of patients defined as obese continues to grow in many westernized nations, particularly the United States (USA). This trend has shifted the perioperative management of obese patients into the realm of routine care. As obese patients present for all types of procedures, it is crucial for anesthesiologists, surgeons, internists, and perioperative health care providers alike to have a firm understanding of their altered multi-organ physiology in order to safely prepare the obese patient for an operation. A careful preoperative evaluation may also serve to identify risk factors for postoperative adverse events. Subsequently, preoperative measures may be implemented to mitigate these complications. In this manuscript we address the major considerations for the preoperative evaluation of the severely obese patient.

Detección de alteraciones respiratorias del sueño en una población bariátrica
Screening for sleep-disordered breathing in a bariatric population.
J Thorac Dis. 2016 Feb;8(2):268-75. doi: 10.3978/j.issn.2072-1439.2015.11.58.
BACKGROUND: Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing frequently associated with obesity. Obese subjects undergoing elective surgical procedures with general anesthesia are potentially at risk if this condition is not identified. Our aim was to assess the prevalence of bariatric patients with undiagnosed OSA following pre-operative assessment and who could benefit from peri-procedural respiratory management. METHODS: Patients who were referred for prospective bariatric surgery were screened using the STOP-BANG questionnaire. If patients scored >4 points they underwent a home-based nocturnal pulse oximetry. Severity of OSA was defined by the 4% oxygen desaturation index (ODI) combined with a physician's review. Data were compared using unpaired two-tailed t-test and Chi-square test. Linear regression models were used to assess associations between clinical parameters. RESULTS: Sleep-disordered breathing of any degree was evident in 103 of 141 patients (73%). Thirteen (9%) patients had severe, 19 (13%) moderate, and 34 (24%) mild OSA, 38 (27%) patients had no OSA. 34 (24%) patients were initiated on continuous positive airway pressure (CPAP) prior to the surgical procedure, 15 (11%) were admitted for further respiratory assessment and two of them were given CPAP following inpatient sleep study. Thirteen (9%) patients were advised to use a mandibular advancement device for mild but symptomatic OSA. Out of all patients, 76 (54%) were advised that no treatment was required. CONCLUSIONS:
OSA is highly prevalent in a cohort of bariatric surgery patients screened with STOP-BANG questionnaires. Almost 3/4 of this cohort have at least some degree of sleep-disordered breathing, and approximately half of them require a plan for the respiratory management perioperatively.
KEYWORDS: Obstructive sleep apnea (OSA); obesity; perioperative risk
IMC como un predictor de potencial intubación traqueal difícil en hombres
BMI as a Predictor for Potential Difficult Tracheal Intubation in Males.
Front Med (Lausanne). 2015 Jun 4;2:38. doi: 10.3389/fmed.2015.00038. eCollection 2015.
INTRODUCTION: Difficult tracheal intubation is a common source of mortality and morbidity in surgical and critical care settings. The incidence reported of difficult tracheal intubation is 0.1%-13% and reaches 14% in the obese population. The objective of our retrospective study was to investigate and compare the utility of body mass index (BMI) as indicator of difficult tracheal intubation in males and females. 
CONCLUSION: In conclusion, our data shows that BMI is a reliable indicator of potential difficult tracheal intubation only in male surgical patients.
KEYWORDS: BMI; difficult; obesity; predictors; tracheal intubation
Curso de Especialidad en Algología 2017-2018
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Universidad Nacional Autónoma de México

Comité Europeo de Enseñanza en Anestesiología
Curso de Actualización en Anestesiología
Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras
Agosto 5-7, 2016. Tijuana BC, México
Información Dr. Sergio Granados Tinajero granadosts@gmail.com 
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