UMLS:C0028754 - FACTA Search

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

Glycosidases are lysosomal enzymes that participate in the catabolism of glycoproteins and other glycoconjugates, and in some way may modify their activity in situations in which carbohydrate metabolism could be altered, such as the case of obesity. Using a fluorometric assay, a study was made of four glycosidase activities: N-acetyl-beta-D-hexosaminidase (NAG), alpha-mannosidase and alpha- and beta-glucosidase in the serum, pancreas, liver and kidney of 22 Zucker fa/fa genetically obese rats and of 23 fa/? controls, both with ages ranging between 13 and 15 weeks. After 12-14 hours fast and prior anaesthesia with sodium pentobarbital intraperitoneally, blood and the afore-mentioned organs were removed for enzymatic study of the serum and the organs after homogenization and centrifugation. In the serum a statistically significant increase in alpha-mannosidase (p < 0.0001) and alpha-glucosidase (p < 0.02) activities was found in the fa/fa obese rats as compared with the controls. No statistically significant differences were found in serum hexosaminidase activity between the two groups, and no serum beta-glucosidase enzymatic activity was detected. In liver, a decrease was observed in hexosaminidase (p < 0.002) and alpha-glucosidase (p < 0.01) activities in the obese rats as compared with the controls. In whole pancreas an increase was found in alpha-glucosidase activity in the obese rats with respect to the controls (p < 0.001), with no statistically significant differences in the hexosaminidase, alpha-mannosidase and beta-glucosidase activities.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enzymatic glycosidase activities in experimental obesity. 142 11

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

Transvaginal ultrasonography has provided new anatomic and pathophysiologic information about the female pelvis. Because of probe proximity to the organ of interest and higher insonating frequency, resolution is dramatically improved. Problems previously encountered during transabdominal scanning, such as obesity, bowel gas, and a retroverted uterus, no longer preclude accurate diagnosis. Patient acceptance is nearly universal. Physiologic information concerning the endometrium and ovarian follicles has improved infertility diagnosis and treatment. Hormonal and vascular Doppler changes can be correlated with cyclic endometrial patterns and follicle size. Oocyte retrieval, management of pre-existing inflammatory disease, and treatment of complications of pregnancy are easier and safer with a transvaginal approach. Uterine malformations, leiomyomas, and cancers are more easily detected in premenopausal and postmenopausal women. The documentation of early intrauterine or ectopic pregnancy has decreased maternal morbidity and mortality. Tube-sparing procedures with preservation of reproductive potential are now more commonly employed due to earlier recognition of unruptured tubal pregnancy. Interventional TVS has led to improved recognition and treatment of pelvic cysts and abscesses and multiple pregnancy. Chorionic villous sampling can be performed more easily without the need for anesthesia, with adequate tissue obtained.
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PMID:Transvaginal ultrasonography. 151 39

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

Difficult tracheal intubation, often unexpected, has been identified as the commonest contributory factor to anesthetic-related maternal death. The ability to predict such cases preoperatively would be of great value. Preoperative airway assessment and potential risk factors for difficult tracheal intubation were recorded in 1,500 patients undergoing emergency and elective cesarean section under general anesthesia. Airway assessment using a modified Mallampati test recorded oropharyngeal structures visible upon maximal mouth opening. Potential risk factors documented were obesity; short neck; missing, protruding, or single maxillary incisors; receding mandible; facial edema; and swollen tongue. Subsequent to induction of anesthesia, the view at laryngoscopy and difficulty at intubation were graded. There was a significant (P less than 0.001) correlation between the oropharyngeal structures seen and both the veiw at laryngoscopy and difficulty at intubation. Univariate analysis demonstrated a significant association between difficult intubation and short neck (P less than 0.001), obesity (P less than 0.0001), missing maxillary incisors (P less than 0.02), protruding maxillary incisors (P less than 0.001), single maxillary incisor (P less than 0.0001), and receding mandible (P less than 0.003). Neither facial edema (P = 0.414) nor swollen tongue (P = 0.141) were found to be associated with difficult intubation. Multivariate analysis removed obesity and missing and single maxillary incisors as risk factors. Obesity was eliminated because of its strong association with short neck. The probability of experiencing a difficult intubation for various combinations of risk factors was determined.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. 161 11

Little information is available about the incidence of severe adverse outcomes, and even less information is available about the identification and quantification of independent predictors of severe perioperative adverse outcomes. The purpose of this study was to identify and quantitate independent predictors of severe perioperative adverse outcomes in a prospective randomized clinical trial of general anesthesia in 17,201 patients. Twenty-nine prognostic variables for 15 severe outcomes in 847 patients were tested by multiple stepwise logistic regressions from which 20 significant (P less than 0.05) predictors were identified. A history of cardiac failure or myocardial infarction less than or equal to 1 yr; ASA physical status 3 or 4; age greater than 50 yr; cardiovascular, thoracic, abdominal or neurologic surgery; and the study anesthetics were significant predictors of "any severe outcome, including death." There were 17 significant predictors for 10 severe cardiovascular outcomes in 608 patients, including a history of ventricular arrhythmia, hypertension, cardiac failure, myocardial ischemia, myocardial infarction less than or equal to 1 yr or myocardial infarction greater than 1 yr, and smoking; ASA physical status; age; cardiovascular, thoracic, abdominal, eyes-ears-nose-throat/endocrine, neurologic, musculoskeletal, or gynecologic surgery; and the study anesthetics. There were 9 significant predictors for 4 severe respiratory outcomes in 163 patients, including a history of cardiac failure, myocardial ischemia, or chronic obstructive pulmonary disease; obesity; smoking; male gender; ASA physical status; abdominal surgery; and the study anesthetics. Colinearity between related prognostic variables (such as disease and ASA physical status) was assessed using progressively segregated groups of variables in eight stepwise logistic regressions. We conclude that the comprehensive stepwise logistic regression of 29 prognostic variables reported here provides a valid estimate of the risks of severe perioperative outcomes associated with general anesthesia.
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PMID:Multicenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes. 172 12

The pharmacokinetics of sufentanil were determined in eight obese (94.1 +/- 14 kg, mean +/- SD) and eight control patients (70.1 +/- 13 kg) anesthetized for neurosurgery. After induction of anesthesia, 4 micrograms/kg of sufentanil was administered in a single intravenous bolus. Multiple arterial samples were obtained at timed intervals over 6 h, and plasma concentrations of sufentanil were measured by radioimmunoassay. Calculation of pharmacokinetic variables from the derived compartmental models demonstrated an increased volume of distribution of sufentanil in the obese (9098 +/- 2793 mL/kg ideal body weight, mean +/- SD) when compared with a control group (5073 +/- 1673 mL/kg ideal body weight) (P less than 0.01) and a prolonged elimination half-life (208 +/- 82 min vs 135 +/- 42 min, P less than 0.05). The total volume of distribution correlated linearly with the degree of obesity, as expressed in percent ideal body weight (r = 0.67). In contrast, plasma clearance was similar in both obese and control groups (32.9 +/- 12.5 vs 26.4 +/- 5.7 mL/kg ideal body weight). The high lipid solubility of sufentanil probably explains the altered pharmacokinetics of this opioid in obese patients.
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PMID:Pharmacokinetics of sufentanil in obese patients. 183 21

A closed-claim analysis of anesthetic-related deaths and permanent injuries in the dental office setting was conducted in cooperation with a leading insurer of oral and maxillofacial surgeons and dental anesthesiologists. A total of 13 cases occurring between 1974 and 1989 was included. In each case, all available records, reports, depositions, and proceedings were reviewed. The following were determined for each case: preoperative physical status of the patient, anesthetic technique used (classified as either general anesthesia or conscious sedation), probable cause of the morbid event, avoidability of the occurrence, and contributing factors important to the outcome. The majority of patients were classified as American Society of Anesthesiologists (ASA) status II or III. Most patients had preexisting conditions, such as gross obesity, cardiac disease, epilepsy, and chronic obstructive pulmonary disease, that can significantly affect anesthesia care. Hypoxia arising from airway obstruction and/or respiratory depression was the most common cause of untoward events, and most of the adverse events were determined to be avoidable. The disproportionate number of patients in this sample who were at the extremes of age and with ASA classifications below I suggests that anesthesia risk may be significantly increased in patients who fall outside the healthy, young adult category typically treated in the oral surgical/dental outpatient setting.
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PMID:Major morbidity or mortality from office anesthetic procedures: a closed-claim analysis of 13 cases. 183 16

End-tidal partial pressure of isoflurane (PE'iso) may be used as a measure of anaesthetic depth. During uptake, an arterial partial pressure (Paiso) which is considerably less than PE'iso (Paiso/PE'iso much less than 1) leads to underestimation of depth of anaesthesia and, during elimination, PE'iso/Paiso much less than 1 will lead to an overestimation of anaesthetic depth. We measured Paiso/PE'iso during a 60-min uptake period of 1% isoflurane and PE'iso/Paiso during the subsequent 60-min elimination period in 26 patients (age 13-88 yr, ASA I-III) undergoing various surgical procedures. After 15 min of isoflurane uptake, Paiso/PE'iso of 26 patients was mean 0.78 (SD 0.10) and this increased only marginally at 60 min (0.79 (0.09)), whereas during elimination, PE'iso/Paiso was in the range 0.79 (0.14)-0.83 (0.11). Predictability of Paiso in a given patient is hindered by the high SD of Paiso/PE'iso and PE'iso/Paiso, but it may be improved by taking into account age, ASA physical status category, vital capacity, inspired minus end-tidal isoflurane partial pressure and arterial minus end-tidal carbon dioxide partial pressure during uptake; and obesity, end-tidal isoflurane partial pressure and arterial minus end-tidal carbon dioxide partial pressure during elimination. However, even with multiple regression analysis (to account for the various possible variables), clinically useful prediction of Paiso/PE'iso and PE'iso/Paiso in a particular patient is not possible (residual SD 0.084 and 0.113, respectively).
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PMID:Is the end-tidal partial pressure of isoflurane a good predictor of its arterial partial pressure? 190 24

The obturator nerve passes in close proximity to the inferolateral bladder wall. Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective to stop adductor spasm during spinal anesthesia. We performed obturator nerve block in 107 cases by use of insulated needle and nerve stimulator, and measured the depth of the obturator nerve and that of the pubic tubercle. Obesity index was positively correlated with the depth of the obturator nerve as well as the pubic tubercle. However, no correlation was found between the obesity index and the difference of the depth of the obturator nerve and the depth of the pubic tubercle. It is suggested that if the needle is advanced in the direction of the obturator canal about 40mm further after reaching the pubic tubercle, the needle reaches the obturator nerve.
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PMID:[A report on 107 cases of obturator nerve block]. 192 Jul 90

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