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. Ortiz VE1, Kwo J2. BMC Anesthesiol. 2015 Jul 4;15:97. doi: 10.1186/s12871-015-0079-8. Abstract 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. PDF Detección de alteraciones respiratorias del sueño en una población bariátrica Screening for sleep-disordered breathing in a bariatric population. Reed K1, Pengo MF1, Steier J1. J Thorac Dis. 2016 Feb;8(2):268-75. doi: 10.3978/j.issn.2072-1439.2015.11.58. Abstract 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 PDF   IMC como un predictor de potencial intubación traqueal difícil en hombres BMI as a Predictor for Potential Difficult Tracheal Intubation in Males. Uribe AA1, Zvara DA2, Puente EG1, Otey AJ1, Zhang J3, Bergese SD4. Front Med (Lausanne). 2015 Jun 4;2:38. doi: 10.3389/fmed.2015.00038. eCollection 2015. Abstract 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 PDF Curso de Especialidad en Algología 2017-2018 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Información / Information 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  Programa

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Cirugía de reemplazo de disco cervical puede aliviar el dolor, entumecimiento y debilidad

Cirugía de reemplazo de disco cervical puede aliviar el dolor, entumecimiento y debilidad

Obesidad en UCI / Obesity in ICU

Agosto 4, 2016. No. 2407

Cuidados intensivos en los obesos durante y después de cirugía de columna Critical care of obese patients during and after spine surgery. Elgafy H1, Hamilton R1, Peters N1, Paull D1, Hassan A1. World J Crit Care Med. 2016 Feb 4;5(1):83-8. doi: 10.5492/wjccm.v5.i1.83. eCollection 2016.Abstract Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes. KEYWORDS: Critical care; Obesity; Spine sugary PDF Curso de Especialidad en Algología 2017-2018 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Información / Information 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  Programa 16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

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Bloqueo de la extremidad superior / Upper extremity nerve block

Agosto 1, 2016. No. 2404

Bloqueo neural de la extremidad superior. ¿Cómo se puede beneficiar, mejorar su duración y seguridad? Una actualización Upper extremity nerve block: how can benefit, duration, and safety be improved? An update. Brattwall M, Jildenstål P, Warrén Stomberg M, Jakobsson JG. F1000Res. 2016 May 18;5. pii: F1000 Faculty Rev-907. doi: 10.12688/f1000research.7292.1. eCollection 2016. Abstract Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effectivepostoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality. KEYWORDS: anaesthesia; axillary plexus; infraclavicular; interscalene; peripheral blocks; supraclavicular; ultra-sound guided; upper extremity block PDF  Curso de Especialidad en Algología 2017-2018 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Universidad Nacional Autónoma de México Información / Information 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  Programa 16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/

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