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

Sixteen extremely obese patients were anaesthetized for intestinal short circuiting operations. Severe obesity may cause pathological cardio-pulmonary changes. Cardiovascular alterations include increased systemic, pulmonary artery and pulmonary capillary venous pressure. Cardiac output, total blood volume and left ventricular work increase. Expiratory reserve volume and consequently functional residual capacity decrease with gross obesity. Functional residual capacity falls below closing volume and inspired gas may be distributed to non-dependent lung zones, resulting in decreased ventilation/perfusion ratios and arterial hypoxaemia. Low total respiratory compliance increases the oxygen cost of the work of breathing. Obesity may change the dose requirements for regional anaesthesia and long-acting muscle relaxants. General anaesthesia may also reduce functional residual capacity. We used a technique of anaesthesia which consisted of epidural analgesia with intra-operative mechanical ventilation and which specifically avoided volatile inhalation agents and long-acting muscle relaxants. All patients were extubated immediately after operation and returned to the recovery room for an average duration of 26 hours. Post-operative treatment included humidified oxygen, chest physiotherapy and elevation of the head of the bed to 45 degrees. Each patient's respiratory progress was monitored by repeated determinations of arterial blood gases and vital capacity and by serial chest X-rays. None of the patients in this group required post-operative tracheal intubation and mechanical ventilation.
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PMID:Anaesthesia for intestinal short circuiting in the morbidly obese with reference to the pathophysiology of gross obesity. 113 75

Major alteration in respiratory mechanics occur in all patients following anaesthesia and thoracotomy because of a decrease in the functional residual capacity with minimal change in the closing volume leading to airway closure during tidal breathing and atelectasis. Diminished pulmonary reserve, because of non-pulmonary and pulmonary risk factors before operation, and/or restrictive ventilation and abnormal pattern of breathing due to postoperative pain sustain and aggravate these changes. These can proceed to postoperative pulmonary complications in some normal, and in many high risk, patients. Detection and correction of pre-existing pulmonary disease, smoking, sepsis and obesity is essential to reduce postoperative morbidity and mortality. Effective postoperative regional analgesia minimizes impairment of pulmonary function, aids in its recovery, and prevents postoperative pulmonary complications. The adjuvant use of chest physiotherapy and incentive spirometry should also help in decreasing the adverse affects of anaesthesia and surgery on the chest and thereby reduce the frequency and severity of postoperative complications.
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PMID:Alterations in respiratory mechanics following thoracotomy. 220 2

The results of 670 consecutive caudal blocks performed by the author for operative obstetrics over 20 years is reported. There was no morbidity attributable to the technique. Satisfactory analgesia was not achieved in 83 patients and obesity was not a major cause of failure. The causes of these failures are discussed. It is recommended that caudal analgesia continues to be used for operative vaginal obstetrics.
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PMID:Caudal analgesia by the obstetrician. 187 88

Extradural sacral (caudal) block was performed in 17 cases (14 patients) of chronic low back pain. In each case 22 ml of a bupivacaine/methylprednisolone solution incorporating a radioopaque dye was injected over a 2-min period. Patients were randomly assigned to receive the injection in the horizontal position or with 15 degrees head-up or head-down tilt applied to the operating table. Results indicate that analgesia is usually more localised than spread of solution determined by x-ray evidence and that higher levels of analgesia are achieved in patients in the head-up position. Possible causes are the differing distribution characteristics of the constituents of the solution and the gravitational effects of posture on cerebrospinal fluid mechanics. Technical problems associated with obesity, congenital abnormalities, vascular uptake of solution, and delayed spread of the injectant due to adhesions are discussed.
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PMID:Spread of local anaesthetic solutions following sacral extradural (caudal) block: influence of posture. 253 84

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

The hyperphagia and obesity induced by ventromedial hypothalamic (VMH) electrolytic lesions in female rats were associated with a 70-94% decrease in the level of beta-endorphin (beta-E) in the hypothalamus and other regions of brain, but not in the pituitary. Dynorphin (Dyn) and methionine-enkephalin (ME) levels were also decreased. Rats with VMH lesions were less sensitive to the inhibitory effect of naloxone on their food-intake. Mice injected with gold thioglucose (GTG) also showed a decrease in the hypothalamic content of beta-E and Dyn and exhibited 30% less analgesia compared to control mice after cold swim stress.
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PMID:Effect of electrolytic and chemical ventromedial hypothalamic lesions on food intake, body weight, analgesia and the CNS opioid peptides in rats and mice. 289 79

In an unblinded study 50 patients undergoing cystoscopic procedures received a spinal anaesthetic of plain 0.5% bupivacaine 4 ml administered in the sitting position at the L3-4 space. There was a correlation between the height of blockade assessed by pinprick analgesia and the degree of obesity of the patients measured by weight, weight/height, and weight/height2. Using this dose of spinal anaesthetic agent, high blockade may be anticipated in obese patients.
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PMID:Influence of obesity on spinal analgesia with isobaric 0.5% bupivacaine. 370 98

Clinical criteria for diagnosis of osteoarthritis are not yet formally established; at present, diagnosis is usually made through physical and radiologic examination and evaluation of synovial fluid. Severe trauma and possibly repeated microtrauma, excessive activity, inactivity, and obesity are believed to aggravate symptoms. Treatment objectives are to reduce pain and improve, or at least preserve, function. Antiinflammatory agents provide relief for many patients, although gastrointestinal reactions may accompany their use. Antispasmodics may be helpful for pain caused by muscle spasm, and intraarticular injections of depocorticosteroids are useful for inflammation. Agents that provide analgesia are an appropriate part of the therapeutic program. Patients should be taught to protect weakened joints through use of orthotics, strengthening exercises, and proper body movement and posture. A supportive physician who encourages a healthy life-style and positive outlook will see better physical as well as emotional results with these patients.
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PMID:Osteoarthritis. Aggravating factors and therapeutic measures. 373 93

Previous research indicates a possible interrelationship between the endogenous opioids (EO), nociception and food-intake. We therefore considered the hyperphagic obese Zucker rat a good candidate for abnormal responses to nociceptive stimuli. Pairs of lean and obese sisters were tested for latency of response to nociceptive stimuli by tail-flick and tail-pinch methods. Obese rats exhibited shorter latencies in each test, (tail-flick, p less than 0.05 and tail-pinch, p less than 0.001). Dose/response curves for morphine analgesia indicate that morphine is less potent in obese than in lean rats (ED50's = 4.87 +/- 0.62 mg/kg and 3.12 +/- 0.41 mg/kg respectively, p less than 0.05). These data suggest a defect in the EO systems of obese Zucker rats.
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PMID:Nociception and opioid-induced analgesia in lean (Fa/-) and obese (fa/fa) Zucker rats. 379 88

In 271 gynaecological or obstetrical patients a "combined anaesthesia method" was applied, consisting of lumbar catheter epidural analgesia and controlled ventilation with nitrous oxide/oxygen. We aim to show that by mere interaction of the local anaesthetic, with nitrous oxide, and the drugs used for premedication and during induction of anaesthesia a stage of sleep can be achieved, which, on the patient's behalf is identical with his idea of "full anaesthesia", while at the same time the use of centrally acting agents can be kept at a minimum. In incidents of sympatho-adrenergic-stimulation due to insufficient cephalad spread of the blockade and not amenable to additional doses of local anaesthetic, i.v. fentanyl or low concentrations of volatile anaesthetics were added. In the postoperative phase the patients showed a high degree of vigilance. Epidural morphine offered best pain relief with full mobility maintained. In cases with postoperative hypertensive crises, morphine was combined with bupivacaine injections. Even marked obesity or senile degenerative changes in the vertebral column proved not to constitute contraindications for this method.
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PMID:[Experiences with combined catheter-peridural anesthesia and nitrous oxide-oxygen ventilation in patients at risk in gynecology and obstetrics]. 649 87


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