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

Pulse oximetry was used to determine the incidence of intraoperative hypoxemia in 108 patients undergoing ambulatory gynecologic operation. Eleven (10%) experienced moderate desaturation (arterial oxygen saturation less than 90%), and 5 (5%) suffered severe hypoxemic episodes (arterial oxygen saturation less than 85%). Among patient risk factors--including operation, body habitus, smoking habits, history of asthma, age, and airway characteristics--an association with moderate hypoxemia was found only with nonlaparoscopic gynecologic operation, obesity, and age over 35 years, and an association with severe hypoxemia was found only with obesity and age over 35. Among operative events--including inspired oxygen concentration, position, mode of ventilation, and anesthesia phase--an association with moderate hypoxemia was found only with the lithotomy position, manual ventilation, and arousal. The cost per patient of monitoring with a pulse oximeter is about +1.35. A cost-benefit analysis reveals that a mortality rate of 1 in 40,000 among patients who actually become moderately hypoxemic would justify the cost of monitoring arterial oxygen saturation. We conclude that pulse oximetry should be part of routine anesthetic monitoring.
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PMID:Hypoxemia during ambulatory gynecologic surgery as evaluated by the pulse oximeter. 368 57

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

Indications for performing cholecystectomy simultaneously with a gastric bariatric operation remain controversial. The extremes are to always perform cholecystectomy or to perform cholecystectomy only when there are palpable stones or the gallbladder is grossly diseased. Since 1975, 136 cholecystectomies have been performed simultaneously in 724 patients who had a gastric bariatric operation. Cholecystectomy had been performed before the bariatric operation in 120 and was required later in 18 patients. The clinical records, anesthesia, pathology, and operative reports provide the data for this study. Simultaneous cholecystectomy was done through the vertical midline incision used for gastric bariatric operation. No patients had the gallbladder bed closed or were drained. Operative cholangiogram were not performed because this procedure would have been difficult and significantly prolonged because of the obesity. No patients have developed postoperative choledocholithiasis. One patient developed a complication related to cholecystectomy, a common bile duct stricture. The length of the operation and the postoperative hospitalization with and without simultaneous cholecystectomy were compared. The results of intraoperative ultrasound studies performed upon these patients are described and discussed. It is concluded that cholecystectomy should be performed simultaneously with all gastric bariatric operations when there is gross or echogenic evidence of gallbladder disease. Cholecystectomy does not significantly prolong or complicate the gastric bariatric operation.
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PMID:Cholecystectomy in morbidly obese patients. 380 Jan 60

Changes in the volume of the trunk were measured in seven supine patients, when anaesthesia was induced with thiopentone i.v. Stereo-photograms were taken before and after induction and measurements of volume calculated from contour plots of a reconstructed stereo image. The changes in volume of the visible part of the trunk were between -846 and +505 ml. No systematic change in total or lower trunk ("abdominal") volume was evident, but there was a significant negative linear relationship (r = -0.87) between upper trunk ("ribcage") volume change and obesity (expressed as actual weight/expected weight). Changes in volume were more evident in the upper parts of the supine subject, in both ribcage and abdomen (P less than 0.05).
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PMID:Stereophotogrammetric analysis of changes in body volume associated with the induction of anaesthesia. 382 76

The present study aimed to measure triglyceride secretion rate (TGSR) into the circulation in ventromedial hypothalamic (VMH) lesioned rats. Average gain of body weight in VMH lesioned rats was 72 +/- 6 g (mean +/- SE, n = 9) in a week; significantly greater than that in controls (6 +/- 2, n = 8, P less than 0.001). TGSR was determined under hexobarbital anaesthesia in fasted rats by measuring the increase in plasma concentration after the triglyceride removal mechanism was blocked by injecting Triton WR-1339. TGSR in VMH lesioned rats was 500 +/- 37 mg/dl of plasma/h; markedly higher than that in controls (239 +/- 12, P less than 0.001). Serum insulin concentration in VMH lesioned rats was 2.26 +/- 0.32 ng/ml; significantly higher than that in controls (0.83 +/- 0.08, P less than 0.001). There was a positive correlation between serum insulin concentration and TGSR in VMH lesioned rats (r = 0.709, P less than 0.05). The increased secretion rate of triglyceride in VMH lesioned rats is discussed in connection with the development of obesity in these rats.
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PMID:Increased triglyceride secretion rate and hyperinsulinaemia in ventromedial hypothalamic lesioned rats in vivo. 389 95

Seventy-one operations are reviewed, in which knees were replaced with the total condylar prosthesis. The follow-up period ranged between 1 and 7 years, with an average of 3.25 years. Osteoarthritis was diagnosed preoperatively in 53 knees and rheumatoid arthritis in 18. The results obtained in cases of osteoarthritis were better than those in cases of rheumatoid arthritis. The prognosis was adversely affected by obesity, preoperative flexion contracture of 30 degrees or more, wound-healing problems, wound infection, and postoperative manipulation under general anesthesia. The overall results were excellent in 48% of cases (34 knees), good in 28% (20 knees), fair in 11.3% (eight knees), and poor in 4.3% (three knees). Failure was experienced in 8.4% of cases (six knees).
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PMID:The total condylar knee prosthesis: a review of 71 operations. 396 41

Details of the techniques and technical problems encountered in over 1000 tubal ligations in Milne Bay Province, Papua New Guinea are described. Discussed are patient selection, preparation and anesthesia, opening the abdomen, finding and ligating the tubes and wound closure. Problems addressed include inadequate anesthsia, difficulty finding the fallopian tubes, adhesions, obesity, a full bladder, the possibility of a tiny umbilical hernia adjacent to the incision and unexpected early ectopic pregnancies. As many grand multiparas from remote villages find it difficult to leave their large families and go to a faraway hospital, they will gladly have the operation done at a nearby health center. Details of techniques and problems that may be encountered when operating at rural health centers are described. It is stressed that tubal ligations must be safe, as painless as possible, and that the patient must not be kept waiting too long for surgery, or she may become frightened and change her mind. It is argued that laparascopy offers no real advantage to an experienced operator in a rural hospital. Tubal ligation can be done more simply and safely by an experienced surgeon under direct vision, using local anesthesia. The methods outlined in this paper have been successful. In the 1st year the method was adopted, 80 patients came for tubal ligation, 139 in the 2nd, 193 in the 3rd and 282 in the 4th year. There were no deaths or serious complications. It seems likely that many maternal and neonatal deaths were prevented by admitting numerous grand multiparas to hospital for delivery and tubal ligations. Tubal ligation used in an appropriate and safe way is preventive surgery. It is often the cheapest and most effective family planning method for women from remote villages.
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PMID:Tubal ligation with local anaesthesia. 404 7

The incidence of hypoxemia in the immediate postoperative period was determined using a pulse oximeter for continuous monitoring of arterial oxygen saturation (SaO2) in 95 ASA class I or II adult patients breathing room air during their transfer from the operating room to the recovery room. Hypoxemia was defined as 90% SaO2 (arterial oxygen partial pressure (PaO2) approximately equal to 58 mm Hg). Severe hypoxemia was defined as 85% SaO2 (PaO2 approximately equal to 50 mm Hg). Hypoxemia occurred in 33 (35%) patients; severe hypoxemia occurred in 11 (12%). Postoperative hypoxemia did not correlate significantly with anesthetic agent, age, duration of anesthesia, or level of consciousness. There was a statistically significant correlation (P less than 0.05) between hypoxemia and obesity. All three patients with a history of mild asthma became severely hypoxemic even though none had perioperative evidence of obstructive disease, also a statistically significant (P less than 0.003) finding.
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PMID:Continuous monitoring of arterial oxygen saturation with pulse oximetry during transfer to the recovery room. 405 Dec 8

This is a report of a pilot program for laparoscopic sterilization with emphasis on surgical and anesthetic technics. In 1971 the program was developed at the North Carolina Memorial Hospital. Subjects were 129 private patients, mostly white, of middle income with 2 or more children, and from 19 to 47 years of age. Follow up of over 90% indicated high patient satisfaction. Complications were few but may occasionally require surgical management and the method should not be considered a minor procedure. At first patients were handled as inpatients for 1 day preceding surgery. Later an outpatient status was adopted. At an earlier visit a history is taken, instructions given by a nurse, the assigned physician (who may be a physician in training) reviews the history, performs a physical examination, and explains the operation to both the patient and her husband. Laboratory work is performed, operative permits are signed, and patients are asked at this time to agree to sterilization by laparotomy if the laparoscopic approach proves infeasible. On the morning of surgery suitable intravenous medication (Valium 5 mg), fentanyl, and atropine are given and followed by pure oxygen inhalation for 3-5 minutes. Pentothal followed by succinylcholine are given and the patient intubated. Anesthesia is maintained by succinylcholine drip and inhalation of nitrous oxide and oxygen. After surgical preparation with Betadine solution, a combination tenaculum-sound is placed in the cervical canal. Pneumoperitoneum is established with carbon dioxide gas through a Verres needle inserted through a small subumbilical incision. The laparoscopic trocar is introduced by enlarging the same incision. After inspection a second 6 mm trocar is inserted just about the tubes and biopsy forceps introduced. The tenaculum in the cervix is used to position the uterus and tubes. After cauterization tubes are divided with the biopsy forceps and a biopsy specimen obtained if possible without undue action on the tube. After inspection for bleeding or injury to other viscera, the instruments are withdrawn. The procedure can be completed in 15 minutes. After recovery from the anesthesia the patient is removed to the recovery area and then the holding area. After 2 or 3 hours she is seen by a physician and discharged if vital signs are stable. Oral and written instructions for her convalescence are given. Patients are requested to return in 2 weeks or to consult a physician in their home area. 30 patients required postoperative hospital admissions: 15 for non-medical reasons (i.e., distance to travel home) and 15 for observation at the physicians' request. These stayed 14 to 24 hours. Nausea and vomiting were indications in 5. :In one case nosebleed following intubation combined with slight elevation of temperature caused a stay of 48 hours. Retrospectively, only 8 of the 15 hospitalized or 6% of all cases required this extra service. In the initial series there was 1 technical failure due to obesity. The average time to resume normal activities was 3 1/2 days. 115 patients (97.4%) of those responding to a questionnaire stated they would recommend the procedure to a friend. The 3 dissatisfied respondents gave no specific reason. Thorough training of the physicians is urged. Use as an office procedure with local anesthesia is not recommended. Single-puncture technic is being tried. Subsequently over 100 additional procedures have been performed.
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PMID:An outpatient program for laparoscopic sterilization. 426 75

A consecutive, randomly allocated, controlled clinical trial of the prophylactic effect of intermittent pneumatic compression of the calf on the incidence of postoperative deep vein thrombosis showed that in patients without malignant disease there was a highly significant reduction in the incidence of thrombosis. In patients with malignant disease the incidence of thrombosis was higher than in those without, and there was no reduction in incidence by the application of intermittent compression. In the absence of malignant disease, severity of operation and the age of the patient were the most significant aetiological factors. We found no relation between the incidence of deep venous thrombosis and obesity, length of preoperative stay, location of hospital, or duration of anaesthesia. We suggest that intermittent pneumatic compression as used in this trial is a safe, effective, and extremely practical method of preventing postoperative deep vein thrombosis in patients not suffering from malignant disease.
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PMID:Prevention of deep vein thrombosis by intermittent pneumatic compression of calf. 500 37


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