Obesidad y anestesia / Obesity and anesthesia

Febrero 13, 2017. No. 2599

Implementación de una recuperación mejorada después del protocolo de cirugía bariátrica: un estudio retrospectivo. Implementing enhanced recovery after bariatric surgery protocol: a retrospective study. Proczko M1, Kaska L1, Twardowski P2, Stepaniak P3,4. J Anesth. 2016 Feb;30(1):170-3. doi: 10.1007/s00540-015-2089-6. Epub 2015 Oct 24. Abstract While the demand for bariatric surgery is increasing, hospital capacity remains limited. The ERABS (Enhanced Recovery After Bariatric Surgery) protocol has been implemented in a number of bariatric centers. We retrospectively compared the operating room logistics and postoperative complications between pre-ERABS and ERABS periods in an academic hospital. The primary endpoint was the length of stay in hospital. The secondary endpoints were turnover times-the time required for preparing the operating room for the next case, induction time (from induction of anesthesia until a patient is ready for surgery), surgical time (duration of surgery), procedure time (duration of stay in the operating room), and the incidence of re-admissions, re-operations and complications during admission and within 30 days after surgery. Of a total of 374 patients, 228 and 146 received surgery following the pre-ERABS and ERABS protocols, respectively. The length of hospital stay was significantly shortened from 3.7 (95 % confidence interval [CI] 3.1-4.7) days to 2.1 (95 % CI 1.6-2.6) days (P < 0.001). Procedure (surgical) times were shortened by 15 (7) min and 12 (5) min for gastric bypass and gastric sleeve surgery, respectively (P < 0.001 for both), by introducing the ERABS protocol. Induction times were reduced from 15.2 (95 % CI 14.3-16.1) min to 12.5 (95 % CI 11.7-13.3) min (P < 0.001).Turnover times were shortened significantly from 38 (95 % CI 44-32) min to 11 (95 % CI 8-14) min. The incidence of re-operations, re-admissions and complications did not change. KEYWORDS: Bariatric surgery; Early recovery after bariatric surgery; Gastric bypass; Sleeve gastrectomy and morbid obesity PDF Anestesia para el súper obeso. ¿Es sevorano superior al propofol con agente único? Estudio doble ciego randomizado Anesthesia management for the super obese: is sevoflurane superior to propofol as a sole anesthetic agent? A double-blind randomized controlled trial. Siampalioti A1, Karavias D, Zotou A, Kalfarentzos F, Filos K. Eur Rev Med Pharmacol Sci. 2015 Jul;19(13):2493-500. Abstract OBJECTIVE: General anesthesia in obese patients is both challenging and demanding. With the rates of obesity in the general population increasing, more patients undergo bariatric surgery. The aim of this study was to compare the performance, effectiveness and recovery from anesthesia of sevoflurane and propofol in combination with remifentanil, with and without bispectral index (BIS) monitoring in super obese patients undergoing bariatric surgery. PATIENTS AND METHODS: In this prospective, double-blind, randomized, controlled study a total of 100 super obese patients (body mass index, BMI > 50 kg/m2) undergoing bariatric surgery were randomly allocated in four groups: a sevoflurane group (n = 25), a sevoflurane with BIS monitoring group (n = 25), a propofol group (n=25) and a propofol with BIS monitoring group (n=25). Hemodynamic parameters, depth of anesthesia, recovery from anesthesia and postoperative pain were recorded. RESULTS: The mean age of patients was 37.7 ± 9.2 years and the median BMI was 57.86 ± 9.33. There were no statistically significant differences between the four groups with respect to patient characteristics, comorbidities and duration of surgery. The intraoperatively mean arterial pressure was significantly higher in both propofol groups. No significant difference was observed between the four groups in respect to heart rate changes during anesthesia. Although the time to eye-opening and extubation was significantly shorter in both propofol groups, recovery from anesthesia, assessed with the Aldrete, Chung and White recovery scores, was significantly faster in sevoflurane groups. No significant difference was observed in postoperative pain between the four groups. CONCLUSIONS: Although both propofol and sevoflurane provide adequate general anesthesia, sevoflurane may be preferable in super obese patients because of superior hemodynamic stability and faster recovery from anesthesia. PDF Obesidad y manejo anestésico Obesity and Anesthesia Management Ismail Demirel, Esef Bolat and Aysun Yıldız Altun Current Topics in Anesthesiology 2017 Abstract The prevalence of obesity is rapidly increasing throughout the world. Correspondingly, anesthetic procedures in obese patients are also increasing due to both treatment of obesity and other surgical problems of obese patients. Anesthesia-related complications are also seen in obese patients than in normal-weighted population. The importance of anesthetic applications in obese patients originates from physiological and pharmacokinetic alterations. Inhalation of these patients via mask or intubation during general anesthesia may be difficult or even impossible. Determination of extubation time after awakening from anesthesia is also a critical decision. Sleep apnea syndrome and postoperative atelectasis are more common in obese patients than in normal-weighted population. Another vital complication that should be emphasized is thromboembolism, whose incidence and severity may be decreased by pharmacological and functional preventive modalities. This patient population has elevated risk of perioperative mortality and morbidity. Prior to any elective surgical procedure, an obese patient should be thoroughly evaluated to check medical conditions that may increase perioperative mortality risk. Since anesthesiologists will gradually encounter more obese patients, they need a better comprehending of the difficulties of obesity during anesthetic procedures and taking more preventive measures for their patients to avoid complications, or rendering them less traumatic, if any. Keywords: obesity, airway PDF Efectos posturales sobre las alteraciones del intercambio pulmonar de gas en la obesidad grave antes y después de la cirugía bariátrica. Postural effects on pulmonary gas exchange abnormalities in severe obesity before and after bariatric surgery. Rivas E1, Arismendi E, Agustí A, Gistau C, Wagner PD, Rodriguez-Roisin R. Minerva Anestesiol. 2016 Apr;82(4):403-10. Epub 2015 Jun 9. Abstract BACKGROUND: We hypothesized that in morbid obesity, pulmonary gas exchange abnormalities will worsen when supine and that bariatric surgery (BS) will mitigate this effect. METHODS: Gas exchange was investigated in 19 morbidly obese and 8 non-obese, age-matched control females, spontaneously breathing ambient air, both upright and supine, before and one year after BS. RESULTS: In control non-obese individuals, no postural changes in arterial blood gases (ABGs) were observed. While obese subjects had more altered PaO2, SaO2 and AaPO2 values than controls (P<0.05 each) when upright, the values unexpectedly remained unchanged when supine. This was also the case in the subset of 6 normoxemic obese but the remaining 13 hypoxemic individuals actually improved ABGs when supine: PaO2 (by +2.7±1.3 mmHg, P=0.06), SaO2 (by +1.5±0.6%), pH (by +0.01±0.01) and AaPO2 (by -3.4±1.4 mmHg); and cardiac output increased (by +0.4±0.2 L·min-1) (P<0.05 each). After BS, PaO2 (from 75.5±2.4 to 89.4±2.4 mmHg), AaPO2 (from 27.0±2.0 to 15.4±2.1 mmHg) (P<0.05 each), and pulmonary gas exchange were improved compared to before BS when upright, but ABGs worsened when supine (PaO2, by -4.6±1.7 mmHg; AaPO2, by +4.2±1.6 mmHg) (P<0.05 each). CONCLUSIONS: Before BS, ABGs are not altered in normoxemic obese subjects moving from upright to supine, even improving in those with hypoxemia when supine. After successful BS, pulmonary gas exchange improved when upright in all subjects but ABGs deteriorated when supine. However, the important clinical observation is the lack of gas exchange deterioration when supine, which may have implications for critical care and anesthesia settings. PDF Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Pie Equino Varo

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Pie Equino Varo

Pie Equino Varo

de Magdalena Garcia-Torres

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Pie Equino Varo from Magdalena Garcia-Torres on Vimeo.

Conceptos sobre columna: Dolor de espalda baja

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Spine Concepts: Low Back Pain

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Publicado el 8 feb. 2017

Dr. Ebraheim animated video illustrates spine concept associated with low back pain. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundati...

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Conceptos sobre columna: Hernia de disco

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Spine Concepts: Disc Herniation

Spine Concepts , Disc Herniation - Everything You Need To Know - Dr. Nabil Ebraheim

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Publicado el 9 feb. 2017

Dr. Ebraheim animated video illustrates spine concept associated with disc herniation. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundati...

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Fracturas proximales del húmero: tratamiento quirúrgico versus conservador

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Proximal Humerus fractures: Surgery Vs Conservative- PROFHER Trial

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Publicado el 19 jun. 2016

Katharine Criner Woozley, MD. Hand and upper extremity surgeon, Albert Einstein Medical Center, Philadelphia, PA From the 8th Annual Philadelphia Orthopaedic Trauma Symposium, June 11, 2016 at Lewis Katz School of Medicine at Temple University

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Lesiones ortopédicas por estallamiento - Principios de tratamiento

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Orthopaedic blast injuries - Treatment principles (OTA lecture series IV D0d)

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Publicado el 14 may. 2016

Narrated, annotated lecture 4 of 4 on blast injuries from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.

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Lesiones ortopédicas por estallamiento: Mecánica de la onda expansiva

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Orthopaedic Blast Injuries: Blast wave mechanics

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Publicado el 14 may. 2016

Narrated, annotated lecture 2 of 4 on blast injuries from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.

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Lesiones ortopedicas por estallido: Trauma penetrante y contundente

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Orthopaedic blast injuries - Penetrating and blunt trauma (OTA lecture series IV D01c)

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Publicado el 14 may. 2016

Narrated, annotated lecture 3 of 4 on blast injuries from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.

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Consejos y trucos para una reducción externa con fijación interna (ORIF) en la meseta tibial

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Tips and Tricks in Tibial Plateau ORIF

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Publicado el 19 jun. 2016

Derek Donegan, MD. Assistant Professor of Orthopaedic Surgery, University of Pennsylvania. 

From the 8th Annual Philadelphia Orthopaedic Trauma Symposium, June 10, 2016 at Lewis Katz School of Medicine at Temple University

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Tips and Tricks in Tibial Plateau ORIF

 

Fracturas difíciles de la rótula ¿Cómo mejorar los resultados?

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Difficult Patella fractures: How to improve Results?

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Courtesy: Matthew Craig, MD, MS, Clin. Asst. Professor of Orthopaedic Surgery, Temple University, Abington Memorial Hospital, Rothman Institute

Saqib Rehman MD Director of Orthopaedic Trauma Temple University Philadelphia Pennsylvania USA www.orthoclips.com

Publicado el 19 jun. 2016 Matthew Craig, MD, MS, Clin. Asst. Professor of Orthopaedic Surgery, Temple University, Abington Memorial Hospital, Rothman Institute Categoría Comedia Licencia Licencia de YouTube estándar