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

Epidural anesthesia using 20 ml of 0.75% bupivacaine at L3-4 with the patient in the left lateral position and the table horizontal was employed for cesarean section in 147 A.S.A. class 1 or 2 parturients under the age of 35 with a single fetus. The height of the analgesia was positively correlated with the body mass index (BMI) (weight in kilograms divided by the height in square meters), a measure of adiposity, and with body weight. Both correlations were statistically significant (p less than 0.001). There was no statistically significant correlation with the patients' height or age. It is concluded that higher levels of epidural block should be anticipated in obese obstetrical patients in proportion to their obesity. Twenty milliliters of 0.75% bupivacaine must frequently be augmented to provide adequate analgesia for cesarean section in thin parturients (BMI below 28) whereas it is too high a dosage for obese patients.
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PMID:Obesity and the cephalad spread of analgesia following epidural administration of bupivacaine for Cesarean section. 718 43

The anaesthetic and surgical problems associated with Caesarean section in eight grossly obese patients (weight 150-204 kg) are described. In addition to an increase in the frequency and severity of the complications of obesity, those weighing more than 150 kg present a panniculus which may weigh 70 kg. Extradural analgesia was used for three patients and general anaesthesia for five (two because of fetal distress). One fetus died in utero after serious and prolonged arterial hypotension in the mother caused by powerful cephalad retraction of the panniculus (extradural analgesia). General anaesthesia was associated with severe episodes of hypertension in two patients.
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PMID:Caesarean section associated with gross obesity. 743 30

Consecutive obese (n = 53) and non-obese parturients (n = 609) were prospectively evaluated during labour to analyse the influence of maternal obesity on labour pain and outcome. Excessive pre-pregnancy weight was classified as a body mass index of 30 kg.m-2 or more. Pain intensity was measured using an 11 point visual scoring scale. Obese parturients had more complicated pregnancies (hypertension and diabetes) and their babies weighed significantly more (3865 g versus 3592 g, p < 0.001). These differences did not affect labour pain experience, or the duration or mode of delivery. Eighty-five percent of the obese parturients and 83% of the controls had high maximal pain scores during the first stage (> 7). Both groups received similar analgesia. More technical problems (p = 0.03) were experienced in establishing epidural analgesia for obese parturients, but this did not influence the success of pain treatment. After delivery, obese women were significantly more content with the pain relief received; only 12% vs 23% in the control group complained of poor pain control (p = 0.03). In this study, obesity and increased fetal size did not complicate labour or its outcome. Critical patient assessment should be emphasised, however, due to the physiological and medical problems present in obese parturients.
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PMID:The effect of maternal obesity on labour and labour pain. 774 49

The obstetrical population is prone to difficult or failed intubation. Control of the airway is complicated by several factors specific to obstetric anesthesia: time of apnea is short due to a reduced functional residual capacity and pregnancy-induced hypertension and obesity are relatively frequent; anesthetist's skill can also be mentioned. The best approach to this problem lies in its prevention, using epidural analgesia as soon as possible. Furthermore, the number of difficult intubations can be considerably reduced by a thorough pre-anesthetic examination. Each anesthetist must keep an algorithm in mind, should a difficult or failed intubation in obstetrical patient occur. Whichever method is used (ventilation through a facial mask or laryngeal mask, transtracheal oxygenation), the anesthetist must never forget that the first priority is always the safety of the mother.
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PMID:[Difficult intubation in obstetrics]. 807 9

The spread of sensory blockade during spinal analgesia using bupivacaine is influenced by a number of factors concerning baricity, positioning, dosage, technique of injection and patient characteristics. The glucose-free 0.5%-solution acts as a hypobaric solution. The interaction of baricity and posture during and immediately after the injection of this solution is of utmost importance. However, the level of analgesia when using hyperbaric solutions seems not to be affected by posture. The dose of bupivacaine is also of great importance, independent of the type of solution used. Of modest importance is patient age, irrespective of baricity, while obesity and injection level only matter when the glucose-free solution is used. Injection speed seems of modest importance, while barbotage and direction of the needle have no or minimal clinical importance. The problem of unpredictability of the sensory blockade, a major one in spinal analgesia, is yet to be solved.
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PMID:[Bupivacaine in spinal anesthesia. The spread of analgesia--dependence on baricity, positioning, dosage, technique of injection and patient characteristics]. 821 98

A retrospective review was performed of 448 consecutive patients undergoing primary, unilateral, bicondylar, and cemented total knee arthroplasty under epidural anesthesia by three surgeons to determine factors contributing to deep vein thrombosis rate. All had venography on the fourth or fifth postoperative day and received aspirin and elastic stockings as their only thromboprophylaxis. The overall deep vein thrombosis rate was 41% (2% had proximal clots). The rate of deep vein thrombosis was not related to obesity, history of heart disease, hypertension, prior malignancy, smoking, diagnosis of osteoarthritis, duration of surgery, type of local anesthetic used, or the use of postoperative epidural analgesia. The rate of deep vein thrombosis varied significantly between surgeons: one surgeon had an overall deep vein thrombosis rate of 58% (proximal thrombi, 4%) whereas the other two surgeons had a deep vein thrombosis rate of 35% (proximal clot thrombi, 1%). A number of possible mechanisms to explain the variation in deep vein thrombosis rates between surgeons are provided.
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PMID:Factors affecting deep vein thrombosis rate following total knee arthroplasty under epidural anesthesia. 847 30

We evaluated the effect of intravenous diltiazem infusion in 105 noncardiac surgical patients. Subjects were elective surgical patients with coronary artery disease and coronary risk factors which were hypertension (WHO standards), diabetes mellitus, hyperlipemia (total cholesterol > or = 220 mg.dl-1), obesity (body mass index : male > or = 26 kg.m-2, female > or = 25) and old age (70 years old or above). The prophylactic intravenous diltiazem infusion (1.0 micrograms.kg-1.min-1) was started immediately after induction of general anesthesia or epidural analgesia and continued until the end of operation. All patients were monitored by ST trend graph during anesthesia, and ischemia pattern was defined as > or = 1 mm ST changes and lasting over 1 min. Ischemic ST-T changes were noted in 4 cases in the operating room. ST depression was noted in 2 cases before starting anesthesia and these 2 cases showed improvement with diltiazem infusion lasting until the end of operation. ST-T changes were noted in 2 cases during surgery and these 2 cases showed improvement with diltiazem isosorbide dinitrate. We conclude that prophylactic intravenous diltiazem infusion may prevent ischemia during noncardiac surgery.
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PMID:[The effect of prophylactic intravenous diltiazem drip infusion on myocardial ischemia during noncardiac surgery]. 922 91

Laparoscopic splenectomy (LS) has recently been gaining acceptance as an alternative to open splenectomy. However, several aspects, such as learning curve, residual splenic function, and management of large spleens, remain controversial. In this paper we present the analysis of technical details and immediate and late outcome of a consecutive series of 64 cases of splenic disorders approached by laparoscopy. Between Feb-1993 and April-1997, 64 patients with a wide range of splenic disorders were treated by laparoscopy, and prospectively recorded. Age, body mass index, operative time, number of trocars, perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia, stay and morbidity were analyzed. Late failures after LS were reevaluated with 99mTc-heat-damaged red blood cells scintigraphy and CT. LS was performed in 61 patients, and two cases with splenic cyst and one splenic artery aneurysm received a laparoscopic partial cystectomy and aneurysmectomy. LS was performed through an anterior approach in 12 patients and laterally in 49. Conversion rate was 6.5%. Accessory spleens were found in 7 patients (7/61, 11.5%). Morbidity was 16%. There was no correlation between the weight of the spleen, platelet count or obesity with operative time. A lateral approach was associated with a decrease in operative time (p < 0.002), postoperative stay (p < 0.001), transfusion (p < 0.04) and number of trocars (p < 0.001). Operative time was significantly longer in large spleens (> 1000 gr) (p < 0.001). However, there were no differences in transfusion rate, stay, morbidity or conversion rate. After a follow up of 12 m, 10 patients revealed a low platelet count. Scintigraphy showed residual splenic tissue in 3 (ITP). A wide range of splenic disorders can be treated by laparoscopy, including enlarged spleens. This technique should be continually audited, but initial results reflect the approach's safety and advantages provided that great technical care is taken and an exhaustive search for accessory spleens is conducted.
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PMID:Laparoscopic surgery for splenic disorders. Lessons learned from a series of 64 cases. 941 9

Internists are frequently asked to do preoperative consultations and to manage perioperative complications. Realistic goals are to identify patient factors that increase the risk of surgery, to quantify this risk in order to make decisions about the appropriateness of and timing of the surgery, to provide recommendations on how to minimize the risk, to identify and manage coexisting medical conditions and their associated medication requirements, to monitor the patient for perioperative problems, and to make recommendations to deal with these problems when they occur. With few exceptions, nonselective imaging and laboratory screening tests have repeatedly been shown to be of little value when the history and physical do not suggest a problem. The risk associated with the planned surgery can be estimated, with the most common serious complications being cardiac events. Updated versions of Goldman's risk indices are particularly helpful for this. Clinical variables are optimally combined with selective stress testing to discern which patients will benefit from preoperative revascularization. This has been studied best in the setting of vascular surgery. A critical guiding principle is that the value of revascularization must be judged in terms of long term gains rather than just immediate perioperative benefit. Other interventions include the selective use of beta blockers, adequate analgesia for all, control of hypertension, and appropriate volume management, especially in the settings of preexisting CHF or valvular disease. It must also be recognized that perioperative ischemia and CHF often present atypically. An approach that combines aspects of both the ACC/AHA and the ACP guidelines seems optimal. A variety of noncardiac issues must also be addressed. Postoperative pulmonary complications are common, especially with preexisting pulmonary disease, thoracic and upper abdominal surgery, and obesity. PFTs and ABGs are indicated in selected patients. Stopping smoking, incentive spirometry, and selective use of bronchodilators and antibiotics are helpful. Patients with rheumatologic diseases have specific concerns based on systemic manifestations of disease including anemia, thrombocytopenia, pulmonary fibrosis, pericarditis, and hypercoagulability; medication effects particularly from steroids and nonsteroidal anti-inflammatory drugs; and specific joint problems including contractures and atlantoaxial joint instability. Diabetes increases the risk of infection and cardiac complications. Prevention of ketoacidosis and glucose control are necessary and can be achieved through a variety of approaches, depending on whether the patient suffers from Type 1 or Type 2 diabetes. The threshold for transfusion has increased in recent years, as has the use of erythropoietin and autologous blood donation. There is no longer an absolute hemoglobin that requires transfusion, although most require transfusion for hemoglobins less than 8 mg/dL, especially in the setting of cardiac disease and bloody surgery. The elderly require surgery at an increased rate and often do not do as well as younger patients. The primary issues are, however, not their age but their increased frequency of underlying disease and diminished reserve. The latter makes them prone to postoperative delirium, sensitivity to medications, and cardiac and pulmonary problems. Despite the many diseases that patients often have and the stresses of surgery itself, modern anesthetic and surgical techniques allow almost all patients to undergo necessary procedures at acceptable risk. The internist plays a critical role in minimizing this risk even further.
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PMID:Recognition and management of preoperative risk. 1046 30

The peptide products of the pro-opiomelanocortin (POMC) gene have established roles in the control of physiological processes as diverse as adrenal steroidogenesis, skin pigmentation, analgesia and inflammation. In the last 5 years, evidence accumulated from murine and human genetic models of disrupted melanocortin signalling has firmly established a central role for a population of hypothalamic neurons expressing POMC in the control of appetite and body weight. Of the five known melanocortin receptors, the MC4R has been most closely linked to body weight regulation. While a-MSH is active at this receptor and suppresses appetite after central injection, important roles for other POMC-derived products have not been excluded. The development of pharmacological agonists acting on, or mimicking, the hypothalamic melanocortinergic pathway may provide exciting opportunities for the therapy of human obesity.
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PMID:The role of melanocortin signalling in the control of body weight: evidence from human and murine genetic models. 1062 76


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