Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment

Background: The incidence of obesity has been dramatically increasing across the globe. Anesthesiologists, are increasingly faced with the care for these patients. Obesity in the pregnant woman is associated with a broad spectrum of problems, including dramatically increased risk for cesarean delivery, diabetes, hypertension and pre-eclampsia. A thorough understanding of the physiology, associated conditions and morbidity, available options for anesthesia and possible complications is therefore important for today's anesthesiologist. Methods: This is a personal review in which different aspects of obesity in the pregnant woman, that are relevant to the anesthesiologist, are discussed. An overview of maternal and fetal morbidity and physiologic changes associated with pregnancy and obesity is provided and different options for labor analgesia, the anesthetic management for cesarean delivery and potential post-partum complications are discussed in detail. Results and Conclusion: The anesthetic management of the morbidly obese parturient is associated with special hazards. The risk for difficult or failed intubation is exceedingly high. The early placement of an epidural or intrathecal catheter may overcome the need for general anesthesia, however, the high initial failure rate necessitates critical block assessment and catheter replacement when indicated

Risk factors for obstructive sleep apnea syndrome in children: state of the art

The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management

Procjena i liječenje otežanog dišnog puta kod pretilih bolesnica: retrospektivno istraživanje u jednom centru

The primary aim of this single center retrospective study was to evaluate difficult mask ventilation (DMV) and difficult laryngoscopy (DL) in a unique group of obese patients. A total of 427 adult patients with body mass index (BMI) ≥25 and surgically treated for endometrial cancer from 2011 to 2014 were assessed. Additional increase in BMI, comorbidities, bedside screening tests for risk factors, and the tools used to manage the patients were noted and their effects on DMV and/or DL investigated. Every escalation in the number of risk factors increased the probability of DMV 2.2-fold, DL 1.8-fold and DMV+DL 3.0-fold. Among bedside tests, limited neck movement (LNM), short neck (SN) and absence of teeth were significant for DMV (p25% were considered. In conclusion, LNM and SN are independent risk factors for developing DMV and/or DL in obese endometrial cancer patients, while BMI increase over 30 was not additionally affecting difficult airway.Primarni cilj ovoga retrospektivnog istraživanja provedenog u jednom centru bila je procjena otežane ventilacije maskom (OVM) i otežane laringoskopije (OL) u specifičnoj populaciji pretilih bolesnica. U istraživanje je bilo uključeno 427 odraslih bolesnica s indeksom tjelesne mase (ITM) >25 koje su kirurški liječene zbog karcinoma endometrija od 2011. Do 2014. godine. Dodatno su bilježeni utjecaj porasta ITM, pridruženih bolesti, čimbenika rizika određenih kliničkim probirnim testovima i alata kojim su se zbrinjavale bolesnice na OVM i/ili OL. Svaka eskalacija u broju rizičnih čimbenika je povećavala rizik OVM za 2,2 puta, OL 1,8 puta i OVM+OL 3,0 puta. Od kliničkih testova, ograničena pokretljivost vrata (OPV), kratak vrat (KV) i nedostatak zuba su bili značajni za OVM (p25, tada deseterostruki porast nije bio nezavisni rizični čimbenik. Zaključno, OPV i KV su nezavisni čimbenici rizika za razvoj OVM i/ili OL u pretilih bolesnica s karcinomom endmetrija, dok ITM veći od 30 nije dodatno uticao na otežani dišni put

A retrospective description of anesthetic medication dosing in overweight and obese children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108075/1/pan12396.pd

Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature.

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management

Dual effects of leptin in perioperative gas exchange of morbidly obese patients

Leptin has shown positive effects on respiratory function in experimental settings. The role of leptin on perioperative respiratory function in morbidly obese patients has not been established. We performed a retrospective analysis of morbidly obese patients undergoing laparoscopic sleeve gastrectomy. Fasting serum leptin and interleukin (IL)-6 were measured preoperatively, and arterial blood gases were obtained pre- and postoperatively. Outcome variables were arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and differences in PaO2 and PaCO2 between pre- and postoperative values (\u394PaO2, \u394PaCO2; postoperative minus preoperative). Patients with lower (<40 \u3bcg/L) and higher ( 6540 \u3bcg/L) leptin levels were compared. Bravais-Pearson's correlation, multiple linear regression, and logistic regression analysis were performed. A total of 112 morbidly obese patients were included. Serum leptin was significantly higher in females than in males (42.86\ub112.89 vs. 30.67\ub113.39 \u3bcg/L, p<0.0001). Leptin was positively correlated with body mass index (r = 0.238; p = 0.011), IL-6 (r = 0.473; p<0.0001), and \u394PaO2 (r = 0.312; p = 0.0008). Leptin was negatively correlated with preoperative PaO2 (r = -0.199; p = 0.035). Preoperative PaO2 was lower, \u394PaCO2 was smaller, and \u394PaO2 was greater in the high leptin group than in the low leptin group. In multiple regression analysis, leptin was negatively associated with preoperative PaO2 (estimate coefficient = -0.147; p = 0.023). In logistic regression analysis, leptin was associated with improved \u394PaO2 (odds ratio [OR] = 1.104; p = 0.0138) and \u394PaCO2 (OR = 0.968; p = 0.0334). Leptin appears to have dual effects related to perioperative gas exchange in obese patients undergoing bariatric surgery. It is associated with worse preoperative oxygenation but improved respiratory function after surgery

Sedation for Esophagogastroduodenal Endoscopy

Different anesthetic techniques and drugs can be used for esophagogastroduedonal endoscopy. However, the scientists are still searching for appropriate drugs and protocols for sedation during esophagogastroduedonal endoscopy. The aim of this review is to discuss the topics related with sedation and esophagogastroduedonal endoscopy in the light of literature. Today standard procedure for diagnostic esophagogastroduedonal endoscopy usually consists of topical pharyngeal anesthesia, minimal sedation or anxiolysis, which may be complemented with analgesia when needed. When a prolonged, complex, or particularly troublesome or painful examination is foreseen, deeper sedation with multiple drugs and in closed observation of a staff may be required

Anestezija kod operacijskog zahvata na hipofizi

Pituitary tumors account for more than 10% of all intracranial tumors. They often present with symptoms of hormonal hypersecretion, although they may also cause hypopituitarism. Transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure, which has certain challenges for the anesthesiologist due to many distinct comorbidities associated with various adenomas. This article provides a review of perioperative concerns regarding transsphenoidal pituitary surgery, encountered in a number of these patients. Thorough understanding of preoperative assessment, intraoperative management and potential complications is fundamental for successful perioperative patient care and avoidance of morbidity and mortality.Tumori hipofize čine više od 10% svih intrakranijskih tumora. Oni se često manifestiraju simptomima hipersekrecije hormona, ali mogu isto tako izazvati hipopituitarizam. Transsfenoidna kirurgija hipofize postala je čest neurokirurški zahvat koji pred anesteziologa postavlja stanovite izazove zbog mnogih istodobno postojećih bolesti udruženih s raznim adenomima. Ovaj članak daje pregled pitanja koja treba razmotriti prije pristupanja transsfenoidnoj kirurgiji hipofize u većine ovih bolesnika. Potpuno razumijevanje prijeoperacijske procjene, intraoperacijskog zbrinjavanja i mogućih komplikacija bitno je za uspješnu perioperacijsku skrb, kao i za izbjegavanje pobola i smrtnosti

Postsurgical behaviors in children with and without symptoms of sleep-disordered breathing

Abstract Background Although some children undergo formal preoperative testing for obstructive sleep apnea, it is likely that many children present for surgery with undetected sleep-related disorders. Given that these children may be at increased risk during the perioperative period, this study was designed to compare postoperative behaviors between those with and without symptoms of sleep-disordered breathing (SDB). Methods This study represents a secondary analysis of data from a study examining the effect of SDB on perioperative respiratory adverse events in children. Parents of children aged 2–14 years completed the Sleep-Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire prior to surgery. Children were classified as having SDB if they had a positive score (≥0.33) on the SRBD subscale. Seven to ten days following surgery, the SRBD subscale was re-administered to the parents who also completed the Children’s Post Hospitalization Behavior Questionnaire. Children were classified as exhibiting increased problematic behaviors if their postoperative behaviors were considered to be “more/much more” relative to normal. Results Three hundred thirty-seven children were included in this study. Children with SDB were significantly more likely to exhibit problematic behaviors following surgery compared with children without SDB. Logistic regression identified adenotonsillectomy (OR 9.89 [3.2–30.9], P < 0.01) and posthospital daytime sleepiness (OR 2.8 [1.3–5.9], P < 0.01) as risk factors for postoperative problematic behaviors. Conclusions Children presenting for surgery with symptoms of SDB have an increased risk for problematic behaviors following surgery. These results are potentially important in questioning whether the observed increase in problematic behaviors is biologically grounded in SDB or simply a response to poor sleep habits/hygiene.http://deepblue.lib.umich.edu/bitstream/2027.42/109540/1/13741_2014_Article_36.pd

Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population

Objective. To obtain normative data for cephalometric measurements of the upper airway in the local Chinese population. Design. Observational study. Setting. University department and teaching hospital out-patient clinic. Subjects and methods. Subjects included 74 healthy patients, 29 males (age range, 18-35 years) and 45 females (age range, 16-42 years), with normal skeletal facial profile, no history of snoring, sleep apnoea, upper airway disease, tonsillectomy or adenoidectomy, obesity, of pathology in the pharynx. Twenty cephalometric airway measurements, including size of the tongue, soft palate, nasopharynx, oropharynx, hypopharynx, and relative position of the hyoid bone and valleculae were obtained. Landmarks on cephalometric radiographs were digitised and measurements were made using a specially designed computer programme. Error analysis of measurements was performed and comparison of measurements according to sex was made. Results. Significant sex dimorphism was seen for the majority of measurements, with the exception of minimal depth of the airway, oropharyngeal depth of the airway, and the soft palate angle with the hard palate. Conclusion. A minimum sagittal dimension of the upper airway was evident despite differences in measurements between sexes. Findings from this study should be a useful reference for the assessment of sleep apnoea in the local population.published_or_final_versio