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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The laryngeal mask airway (LMA) provides a patent airway when placed 'blindly' into the hypopharynx. At the laryngeal side it is supposed to form a seal surrounding the laryngeal inlet with the epiglottis lying outside the mask aperture. This study is designed to assess the prelaryngeal position of the mask by the fibreoptic technique. METHODS. After approval by the local ethical committee and informed consent, 100 adult patients (ASA groups I and II) undergoing general anaesthesia for extracorporal stroke wave lithotripsy (ESWL, Lithotripter HM 3, Dornier) of the kidney were studied. Anaesthesia was induced with propofol (1.5-2.5 mg.kg-1) and fentanyl (1-1.5 micrograms.kg-1) and maintained with isoflurane and N2O (65% in O2) as clinically indicated. The LMA was left in situ until the patients opened their mouth on command. Monitoring consisted of an ECG (SMV 104-D, Dornier), a pulse oximeter (Nellcor 200, Draeger), and a non-invasive blood pressure monitor (BP 103 N, Hoyer). Clinical assessment of airway patency and fibreoptic laryngoscopy (BF Typ 10, Olympus)--immediately and 20 min following the insertion of the LMA--were performed by two observers. RESULTS. The insertion of the LMA was successful on the first attempt in 89 patients while 5% required two, 4% three and 2% four attempts. 'Blindly' inserted without neuromuscular blockade the LMA provided a clinically sufficient airway in all patients. A central position of the LMA was assessed in only 59% of the cases. In 4 patients the mask was riding on the vocal folds. Positioned at the posterior larynx the cuff produced a compression of the laryngeal orifice when insufflated. Oblique insertion of the LMA or oblique head position during insertion produced a misplacement of the LMA. In 5 cases the LMA followed lateral movements of the head without losing its central position. In 87% the epiglottis was within the lumen of the LMA. Secretions inside the mask lumen or at the anatomic structures were seen in 36%. During manual ventilation with high inspiratory pressure (> 25 cm H2O) the oesophagus opened in 10 cases. CONCLUSIONS. Previous studies have suggested that the LMA takes a 'perfect' position at the laryngeal side when a clinically patent airway is recognized. In contrast, our results demonstrated that a central position of the LMA is achieved in only 59% of the cases. Our results indicate that epiglottic downfolding or left/right side or anterior/posterior misplacement are common but generally provide a satisfactory patent airway. This is consistent with fibreoptic findings in children and radiological observations in adults. The LMA is an essential enrichment to conventional airway management. It provides a better seal than the face mask, especially in bearded or in old patients where the facial contours are often not suited to the mask. Ideal indications seem to be elective operations of intermediate duration (1-2 h). The LMA does not protect against aspiration. For patients who are at risk of regurgitation of gastric contents, use of the LMA is absolutely contraindicated. Relative contraindications are local pathology of the pharynx and situations with low pulmonary compliance and/or high airway resistance (massive obesity, asthma, etc.), especially during controlled ventilation. Further studies are necessary to establish definite indications for the application of the LMA.
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PMID:[Fiberoptic determination of the position of the laryngeal mask]. 148 77

While the number of patients at risk for vomiting and aspiration has been reported to be high, the incidence of clinically important pulmonary aspiration is low. We sought to define the incidence of gastroesophageal reflux (GER) and to correlate this with the clinical variables of obesity, history of oesophagitis, bucking and changes in body position. Continuous oesophageal pH measurement was used to determine the frequency of gastroesophageal reflux in 44 patients having general anaesthesia for elective surgical procedures. Acid reflux to a pH value of less than four occurred in seven patients (15.9%) during anaesthesia. This was associated temporally with straining on the endotracheal tube in six subjects (13.6%). We conclude that traditional risk factors are not always predictive of those patients at risk of regurgitation and aspiration.
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PMID:Gastroesophageal reflux during anaesthesia. 159 71

Evaluation without catheterization of patients with valvular heart disease implies that diagnosis based upon non-invasive techniques alone are qualitatively and quantitatively correct. The diagnosis should indicate not only the valvular lesion in question but should give information about associated conditions that could influence management decisions (whether to operate or not or whether to modify the intended operation). A review of the literature shows that in mitral stenosis (MS), both pressure gradient and valve area can be obtained non-invasively (rest/exercise). These data, combined with the ultrasound appearance of the valve, subvalvular apparatus, chamber sizes, assessment of associated regurgitation and eventual pulmonary hypertension, permit a complete evaluation of the MS patient. Thus, it can be concluded that in experienced hands, the large majority of patients with MS can be assessed reliably non-invasively for clinical screening and for valve surgery. Excluding those in whom coronary angiography is mandatory, cardiac catheterization should be required only infrequently (in less than 10%). Cardiac catheterization should, however, be carried out in patients in whom technical reasons make ultrasound examinations incomplete (obesity or respiratory disease), and in patients in whom there is a discrepancy between the physical signs and the Doppler ultrasound.
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PMID:Does mitral stenosis need invasive investigation? 193 32

Transthoracic two-dimensional echocardiography (TTE) has been an accepted noninvasive procedure used to diagnose infective endocarditis by demonstrating the presence of vegetations and other complications such as ring abcess, mycotic lesions or sinus of valsalva aneurysm. Moreover, complementary Doppler and Color Flow imaging are very useful in detecting early valvular regurgitation and in evaluating the severity of such regurgitant lesions. Occasionally, TTE fails to provide an adequate quality of imaging because of the patient's obesity, chest deformity or emphysema. Transesophageal echocardiography (TEE) on the other hand, a relatively new technique, allows ultrasonic imaging of the heart through the esophagus and provides a clear visualization of all cardiac structures without any interference from the lungs, chest wall or rib cage. We present a case of aortic valve endocarditis diagnosed by TEE.
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PMID:Transesophageal echocardiography (TEE): its diagnostic value in endocarditis. 227 24

To assess the limitations of 2 Dimensional Color Doppler Echocardiography in the evaluation of cardiac anatomy in children with congenital heart disease. 2DCDE were performed in 140 infants and children before cardiac catheterization and/or operation or autopsy. The segmental echocardiographic analysis included determination of intracardiac, great artery, systemic venous and pulmonary venous anatomy. Among 140 patients there were 270 separate cardiovascular abnormalities of which 215 (80%) were identified by 2D echo. There were 55 (20%) false negative diagnosis by 2DE. Small VSD, unusual location of PDA, stenosis of pulmonary arterial and venous system, intra pulmonary arterio-venous fistula and pseudotruncus were the lesions most likely to be misdiagnosed by 2DE. Color Doppler was useful to detect abnormal flow of valvular regurgitation or left to right shunt. Doppler is useful to detect abnormal flow from obstruction or regurgitation or left to right shunt and may be used to predict the pressure in the chambers of the heart and great artery. General limitation of 2DCDE to diagnose CHD include; obesity and emphysematous child, some inherent limitation in each instrument and also inexperienced echocardiographer.
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PMID:Limitation of 2 dimensional color Doppler echocardiography in the diagnosis of congenital heart disease. 238 Jun 48

Few data are available regarding the prevalence and causes of false-negative auscultation (mis-auscultation) of aortic (AR), mitral (MR), or tricuspid regurgitation (TR), and there are no such data that are relevant when the patient's pretest probability of having regurgitation is unknown. The authors therefore studied 294 patients examined by pulsed Doppler echocardiography. On 755 examinations (2.57 examinations per patient), Doppler velocity patterns typical of AR, MR, or TR were found in 63, 96, and 49 patients, respectively. For all three murmurs, mis-auscultation was the rule, rather than the exception, with sensitivities of auscultation ranging from 0 to 37%, depending (but weakly) on the site of the murmur and the years of training of the observer. Specificity of auscultation was high (85% to 100%). The factors associated with the mis-auscultation of AR were poor image quality in the echocardiograms, absence of cardiomegaly, and less experience of the examiner. The probability of missing MR increased in the presence of coronary artery disease (CAD) or if the examiner had less experience. The likelihood of missing TR by auscultation was increased by CAD, obesity, chronic obstructive pulmonary disease, or the absence of cardiomegaly. This study suggests that there is a high prevalence of "silent" murmurs, and that not hearing a regurgitant murmur does not suffice to rule out the presence of regurgitation.
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PMID:Causes of false-negative auscultation of regurgitant lesions: a Doppler echocardiographic study of 294 patients. 297 89

Transesophageal echocardiography has been proven to be of particular value in all patients with transthoracic echocardiograms of low quality related to pulmonary emphysema, obesity and chest deformation as well as in intensive care unit patients. Similarly, transesophageal Doppler echocardiography is of particular value in all cases in which the transthoracic Doppler, due to methodological problems, is of limited value. Mitral regurgitation can be detected and quantified and flow direction described. Only in 12/25 patients with mild, 11/12 patients with moderate and 5/8 patients with severe insufficiency was regurgitation detected by transthoracic echocardiography as compared to transesophageal echocardiography with which the lesion was consistently detected. In two patients with severe and clinically-inapparent mitral regurgitation related to papillary muscle rupture, the diagnosis was established only by the transesophageal approach in an emergency situation. Atrial septal defects were detected in 8/15 patients and the size of the defect analyzed. With transesophageal Doppler echocardiography, the relation of left-to-right and right-to-left shunts could be described. In 7/16 patients with aortic dissection, true and false lumen were differentiated by analysing the flow pattern within both lumina. In 9/16 patients differentiation was enabled through delineation of the false lumen which was filled with thrombotic material. Detection of aortic regurgitation and tricuspidal regurgitation is possible but analysis of flow patterns is difficult because flow direction is nearly orthogonal to the ultrasound beam. First attempts to quantify cardiac output have been performed. For the future, transesophageal color flow Doppler mapping appears to be a most promising method.
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PMID:[Diagnostic value of the transesophageal Doppler echocardiography]. 330 69

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic recordkeeping system of the Department of Anaesthesia and the computer-based register of diagnoses of in-patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty-three cases of aspiration were retrieved from the file of anaesthetic records and four from the in-patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e.g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e.g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x-ray. Fifteen patients (17%) needed mechanical ventilation, and four died.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. 375 72

A survey of 200 patients ranging in age from 5-21 yr was undertaken in 3 facilities in central Pennsylvania: state- (100), county- (13), and privately-operated (66), together with 21 children being cared for at home. Their diagnoses included chromosomal, metabolic, and anatomic abnormalities, and other encephalopathies. The following nutritional problems were identified: 1) inadequate nutrient intake due to feeding technique, swallowing difficulties, or regurgitation; 2) obesity and low activity level; 3) constipation; 4) nutrient-drug interactions and allergies; and 5) inadequate standards with which to compare growth and adequacy of nutrient intake. The nutritional problems encountered in these pediatric patients with neuromotor disorders warrant management by a physician-nutritionist team skilled in nutritional assessment and techniques of providing nutritional support.
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PMID:Survey of nutritional problems encountered in children with neuromotor disorders. 719 14

Four hundred and thirty patients with grade 2 or 3 esophagitis were treated after 2/1 randomization for 8 weeks with omeprazole 20 mg (n = 294) or ranitidine 150 mg bid (n = 136). Apart from treatment, 8 epidemiological factors (gender, age, occupation, obesity, smoking, alcohol, NSAID, and coffee or tea consumption), 5 clinical factors (day/night pain distribution, burning score, severity of regurgitation and of dysphagia, number of painful episodes requiring prescription of an antisecretory agent during the previous year, and onset of symptoms before age 30) and 3 endoscopic factors (grade and upward extension of esophagitis, and existence of hiatal hernia > or = 5 cm) were analysed. The influence of these factors on healing at 8 weeks and on changes in symptoms was evaluated by multivariate analysis. 92.1% of patients enrolled were analyzed. In comparison with ranitidine, omeprazole increased the percentage of healed patients (93% v. 67.5%, p < 0.001) and the rapidity of disappearance of symptoms (5 days v. 7 days, p < 0.001). Independent good prognostic factors associated with healing rate were treatment with omeprazole (p < 0.001) and grade 2 esophagitis (p < 0.001) while those associated with the disappearance of symptoms were a low burning score (p = 0.001), advanced age (p = 0.004), treatment with omeprazole (p = 0.005), the absence of any occupation (p = 0.01) and male gender (p = 0.017). The results of this study show that, apart from treatment, endoscopic factors are predictive of the healing of reflux esophagitis treated by antisecretory agents while clinical factors are more important with regard to the disappearance of symptoms.
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PMID:[Prognostic factors influencing healing of reflux esophagitis. A controlled trial of omeprazole versus ranitidine. Study group Omega]. 823 92


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