Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case is reported of acute respiratory failure occurring during upper abdominal surgery in a patient not previously known to have chronic respiratory failure. Preoperatively, this 68 year old patient presented with mild obesity, slight effort dyspnoea and paralysis of the right hemidiaphragm, a sequela of polytrauma she suffered the year before. Respiratory tests were not considered useful with regard to the results of clinical examination. Moreover, she had already several previous general anaesthetics without any problems. A thoracic epidural anaesthesia was performed with a mixture of 150 mg lidocaine, 37.5 mg bupivacaine with adrenaline and 100 micrograms fentanyl, injected in the T8-T9 epidural space via a catheter. Ten minutes after the starting of surgery, the patient became agitated and complained of difficulty in breathing. Blood gas analysis showed hypercapnia, with respiratory acidosis (Pao2: 28.19 kPa; Paco2: 9.2 kPa; pH 7.273). Clinical examination revealed a bilateral Horner syndrome (T1-T4 sympathetic blockade). The patient was intubated and ventilated after adequate sedation. She was extubated 3 h 30 min after the initial epidural injection. Epidural analgesia was maintained during 72 h, with 0.1% bupivacaine, with no recurrence of respiratory failure.
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PMID:[Transient acute respiratory failure and thoracic epidural anesthesia]. 273 73

Halothane is metabolized by an oxidative pathway to stable, nonvolatile end products, trifluoroacetic acid (TFAA) and bromide (Br-), and by reductive pathways to Br-and inorganic fluoride (F-). There is evidence that both oxidatively and reductively formed intermediates may produce hepatotoxicity, although the exact etiology of the fulminant hepatic necrosis seen in humans is unproven. Obese patients receiving volatile anesthetics exhibit higher serum anesthetic metabolite concentrations than do normal-weight patients, and thus might be at greater risk of hepatotoxicity because of higher concentrations of reactive intermediates from halothane metabolism. To eliminate the variables inherent in human clinical studies leading to confounding interpretation of data, this study determined the contributions of oxidative and reductive pathways to halothane metabolism in an animal model of human hypertrophic obesity, the most common form of human obesity. Eight pairs of obese (high-fat diet) and normal-weight (standard chow), male Fischer 344 rats were anesthetized with halothane for 4 h at an inspired concentration of 0.78%. Serum and urinary concentrations of TFAA, Br-, and F-were measured. Thirty-six hours following halothane anesthesia, mean serum TFAA concentrations peaked at 7.3 +/- 1.1 mM in obese rats and 4.7 +/- 0.7 mM in nonobese rats. TFAA urinary excretions during the 180-h period postanesthesia were 519 +/- 69 and 336 +/- 22 mumol, respectively. Peak serum Br- concentrations were 9.1 +/- 1.0 and 6.9 +/- 0.6 mM for obese and nonobese rats, respectively, and Br-urinary excretions were 127 +/- 30 and 79 +/- 14 mumol, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Metabolism of halothane in obese Fischer 344 rats. 277 71

514 patients with total hip replacement were operated in 3 years in our county hospital. The patients were divided in two groups: 1. high risk patients: these patients had an antibiotica prophylaxis with 3 doses of 2 g of cefamandole beginning at the time of the induction of the anaesthesia; 2. patients without risks: they had no antibiotica. The two groups of patients were controlled at 3 and 12 months after the operation. 159 patients had a risk for an infection and had antibiotica, 355 patients had no antibiotica. The infection rate after 1 year was 0.6% in the group of patients with antibiotica, and 1.4% in the group of patients without antibiotica. This gave no statistical significance. The only statistical difference between the 2 groups was a significantly higher rate of urinary infection in the group with antibiotica. Thus it has been shown that urinary infections after total hip replacement correctly treated with antibiotica are not a high risk for an infection in the prosthesis. We conclude that antibiotica prophylaxis for total hip replacement in patients with high risk factors (like diabetes, corticotherapy, intraarticular injection, obesity and operation on the same hip) may help to have a postoperatively low infection rate, in our case 0.6%.
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PMID:[Total hip prosthesis with or without preventive use of antibiotics]. 277 25

A catheter in the epidural space can be the cause of various iatrogenic complications. In order to avoid leaving too great a length in the lumbar epidural space during epidural anaesthesia, graduated Tuohy needles can be used (Perifix), together with graduated epidural catheters. On the latter, a special marking shows that, when it reaches the needle hub, the catheter tip is at the needle bevel. Approximately 5 to 7 cm of catheter length are introduced into the epidural space. The needle is removed and placed upside down next to the catheter, with the hub in contact with the patient's skin. In this position, the distance between the special marking on the catheter and the graduation on the needle which marked the skin level is equivalent to the length of catheter in the epidural space. This distance, and therefore catheter length, can then be reduced to about 4 cm by carefully withdrawing the catheter. Some possible improvements of catheters and needles are discussed. Knowing exactly how much catheter is within the epidural space could be of particular importance whenever that space is uncommonly far from the patient's skin: obesity, oedema, use of the paramedian route or a very oblique angle of the needle in the sagittal plane.
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PMID:[Lumbar epidural catheterization: estimation of the length of the inserted catheter]. 278 95

With the object of illustrating the immediate postoperative complications connected with total hip replacement, a material of 512 hip replacements carried out in the Orthopaedic Department in Viborg Hospital during the period 1982-1987 was reviewed. Complications of significance for the postoperative course occurred in 16% and the mortality was 0.4%. The complications of greatest significance were cardiac (3.3%), renal involvement (2.5%) and thromboembolic complications (3.5%) (pulmonary embolism 1.8% and deep venous thrombosis 2.9%). Advanced age, preoperative cardiovascular conditions and obesity predisposed to these complications and, similarly, increased frequency of cardiac complications was found with increased duration of anaesthesia. Finally, a connection was found between peroperative and postoperative episodes of hypotension and renal involvement.
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PMID:[Immediate postoperative complications after total hip replacement]. 281 81

Despite the contention by some that local anesthesia is a preferred alternative to general anesthesia for laparoscopic sterilization, there have been no randomized studies comparing these techniques. To better characterize the relative safety and acceptability of these techniques for laparoscopic sterilization, we randomly assigned 100 women undergoing bipolar electrocoagulation or spring clip application to either local or general anesthesia. Of the 53 women assigned local anesthesia, four had their procedures completed using another technique because of technical problems related to obesity. Thirteen other obese women, however, underwent successful surgery with local anesthesia. Women undergoing local anesthesia had a slightly shorter anesthesia time (30 versus 36 minutes) and recovery room stay (65 versus 78 minutes). Women having general anesthesia were 2.3 and 1.5 times more likely to have maximum systolic and diastolic blood pressures above 160 and 90 mmHg, respectively. They were also 5.7 times more likely to have a maximum heart rate 110 or higher. Patient movement was reported to be a concern in five women undergoing general anesthesia, but in none having local anesthesia. An equal percentage (80%) of women in each group expressed satisfaction with their anesthetic technique.
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PMID:Local versus general anesthesia for laparoscopic sterilization: a randomized study. 296 Sep 25

Within recent years female sterilization has gained a place of great importance as an effective contraceptive method. Nowadays sterilization is hardly subject to any formal restrictions, but is solely the responsibility of the woman concerned, the couple or the physician. The indications for sterilization may be divided into two main groups, namely for medical indications and family planning. Sterilization is carried out on the uterus or tubes. Today the method of choice is laparoscopic tubal sterilization. The most frequently used procedure and the safest way of tubal occlusion is bipolar electrocoagulation of the entire isthmic tubal portions without additional section of the tubes. The complication rate in laparoscopic tubal sterilization depends on the type of anaesthesia, on the skill of the operator and on patient risk factors such as obesity etc. Minor intraoperative complications are of little importance since they are easily remedied during laparoscopy. Severe complications are rare, but have to be corrected immediately by laparotomy. Pregnancies on account of failure in sterilization procedure may be due to the occlusion technique, the lack of experience of the operator, the timing of sterilization and the observation period. Altogether 2372 laparoscopic tubal sterilizations were performed at the University Department of Obstetrics and Gynaecology in Graz between January 1st, 1975 and December 31st, 1985. During these eleven years a specific technique has been developed, whereby standard methods were simplified and improved. No intrauterine cannula for mobilizing the uterus is applied to avoid infection or perforation. The preferred "single-puncture technique" offers many advantages over the older "double-puncture technique", since fewer instruments are needed and the operation is less time-consuming, eliminating the danger of a second puncture. Moreover, the procedure is easier to perform and the cosmetic result better. In high-risk patients, especially the extremely obese, the laparoscopic technique has been improved by a special method of introducing the trocar.
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PMID:[Sterilization of the female with special reference to laparoscopic tubal sterilization]. 296 70

Factors related to risk of perioperative pulmonary complications include site of incision, obstructive lung disease, prolonged anesthesia time, smoking history with productive cough, and obesity. Hypercapnia is a consistent indicator of high risk. There is no difference between spinal and general anesthesia with regard to risk of pulmonary complications. In patients being evaluated for lung resection, high-risk indicators include predicted postoperative forced expiratory volume in one second of less than 1000 mL, hypercapnia, severe dyspnea on exertion, or advanced age when it is associated with advanced cardiopulmonary disease. Newer methods of assessing cardiopulmonary reserve may prove useful in identifying which patients with one or more of these risk factors are suitable operative candidates. Prevention of postoperative complications in chronic obstructive pulmonary disease patients should begin in the preoperative period with discontinuation of smoking at least eight weeks before surgery and vigorous pulmonary toilet in the 48 to 72 hours before surgery. Prophylactic lung expansion maneuvers can be effective in decreasing the incidence of postoperative atelectasis in high-risk patients undergoing high-risk operations.
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PMID:Preoperative pulmonary evaluation. 233 Nov 91

The advantage of antibiotic prophylaxis using a single dose of 2 g of cefotetan, administered during the induction of anesthesia, was studied in 71 patients undergoing an abdominal hysterectomy and presenting at least one of the following risk factors: obesity or procedure exceeding two hours. After random selection, 33 patients were treated, 38 were not and constitute the reference group. Comparison between the two groups shows a significant difference concerning the general morbidity, post-operative fever, urinary infection and abdominal wall abscess. Considering the excellent tolerance of the treatment and the fact that it is easy to use and inexpensive, antibiotic prophylaxis with cefotetan is quite interesting for this type of surgery.
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PMID:[The value of antibiotic prophylaxis using cefotetan in high-risk abdominal hysterectomy. Apropos of a prospective randomized study of 71 patients]. 306 Sep 67

Alfentanil is a short acting opioid that has an established place in anaesthesia. Its predictable pharmacokinetics and pharmacodynamics, particularly its rapid termination of effect and haemodynamic stability, have led to its use by continuous intravenous infusion both during anaesthesia and more recently in critically ill patients. Fine control of a potent analgesic that has respiratory depressant and antitussive properties would be particularly advantageous in this group, offering patients an improvement in comfort without increasing the risk of oversedation. Pharmacokinetic studies of alfentanil have demonstrated wide interindividual variations. This may be due to a wide variety of factors including age, obesity, hepatic dysfunction, changes in regional haemodynamics, sex, and alterations in plasma protein binding ability and concentration. The importance of pharmacogenetic differences and tolerance to alfentanil remains to be elucidated. Renal disease does not appear to significantly alter the pharmacokinetics of this agent, which may make it particularly useful in this situation. Since alfentanil does not depress conscious level or produce anxiolysis, additional agents such as a benzodiazepine will be necessary to provide adequate sedation. The difficulties in accurately predicting the response of an individual critically ill patient necessitate careful and continuous dose titration of alfentanil according to the clinical response.
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PMID:Alfentanil infusions in patients requiring intensive care. 314 17


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