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Schraverus P, Kuijpers MM, Coumou J, Boly CA, Boer C, van Kralingen S. Level of agreement between cardiac output measurements using Nexfin®and thermodilution in morbidly obese patients undergoing laparoscopic surgery. Anaesthesia 2016; 71:1449-1455. [DOI: 10.1111/anae.13627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 12/11/2022]
Affiliation(s)
- P. Schraverus
- Department of Anaesthesiology; VU University Medical Centre and Onze Lieve Vrouwe Gasthuis; Amsterdam the Netherlands
| | - M. M. Kuijpers
- Department of Anaesthesiology; VU University Medical Centre and Onze Lieve Vrouwe Gasthuis; Amsterdam the Netherlands
| | - J. Coumou
- Department of Anaesthesiology; Onze Lieve Vrouwe Gasthuis; Amsterdam the Netherlands
| | - C. A. Boly
- Department of Anaesthesiology; VU University Medical Centre; Amsterdam the Netherlands
| | - C. Boer
- Department of Anaesthesiology; VU University Medical Centre; Amsterdam the Netherlands
| | - S. van Kralingen
- Department of Anaesthesiology; Onze Lieve Vrouwe Gasthuis; Amsterdam the Netherlands
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Rizzuto I, Odejinmi F, Al-Samarrai M. Can Body Mass Index Influence the Outcome of a Laparoscopic Hysterectomy? J Gynecol Surg 2014. [DOI: 10.1089/gyn.2012.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ivana Rizzuto
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
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Gaszynski T, Szewczyk T. The influence of laparoscopic vs. open gastric bypass on hemodynamic function in morbidly obese patients during general anesthesia. Wideochir Inne Tech Maloinwazyjne 2014; 9:83-8. [PMID: 24729814 PMCID: PMC3983554 DOI: 10.5114/wiitm.2014.40988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 06/15/2013] [Accepted: 08/13/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The open or laparoscopic procedure has an important influence on the hemodynamic function in morbidly obese patients undergoing bariatric surgery. The anesthesiologist and surgeon must be aware of changes in hemodynamic performance during laparoscopy or laparotomy under general anesthesia. AIM TO EVALUATE AND COMPARE THE HEMODYNAMICS IN TWO TYPES OF SURGERY: open vs. laparoscopic. MATERIAL AND METHODS After obtaining the local ethics committee approval 60 morbidly obese (MO) patients (body mass index ≥ 40 kg/m(2)) scheduled for elective open or laparoscopic Roux-en-Y gastric bypass were included. Patients were allocated to study groups depending on the scheduled type of surgery (no randomization). General anesthesia with sevoflurane was performed. The hemodynamic parameters were recorded using a HemoSonic 100 device - a transesophageal Doppler measurement at time points: T1 - initial, T2 - after creating pneumoperitoneum (group PP) or opening the abdomen (group OP). RESULTS Complete data were collected on 28 patients in group LP and 21 in group OP. There was no statistical difference between groups in demographic data. At time point T2 in both groups the parameters stroke volume, peak velocity and cardiac index decreased, and total systemic vascular resistance increased significantly compared to T1 (p < 0.05). In group LP the parameters cardiac output and acceleration (Acc) of blood decreased significantly compared to T1 (p < 0.05). There were significant differences between groups (p > 0.05) in cardiac output, total systemic vascular resistance and Acc, which were significantly higher in the OP group. In both groups mean arterial pressure increased and heart rate stayed similar to T1 with no significant difference (p > 0.05). No complications were observed. CONCLUSIONS Pneumoperitoneum has a significant negative influence on hemodynamic function during laparoscopic bariatric procedures compared to open surgery in morbidly obese patients.
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Affiliation(s)
- Tomasz Gaszynski
- Department of Emergency and Disaster Medicine, Chair of Anesthesiology and Intensive Therapy, Medical University of Lodz, Poland
| | - Tomasz Szewczyk
- Department of Gastroenterological, Oncological and General Surgery, Barlicki University Hospital, Lodz, Poland
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Remístico PPJ, Araújo S, de Figueiredo LC, Aquim EE, Gomes LM, Sombrio ML, Ambiel SDF. Impact of alveolar recruitment maneuver in the postoperative period of videolaparoscopic bariatric surgery. Rev Bras Anestesiol 2011; 61:163-8, 169-76, 88-94. [PMID: 21474024 DOI: 10.1016/s0034-7094(11)70021-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 09/09/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary complications in bariatric surgery are common and, therefore, alveolar recruitment maneuvers (ARM) have been used to prevent or reduce them in the postoperative period (POP). The aim of this study was to evaluate the impact of ARM performed intraoperatively in patients undergoing bariatric surgery by videolaparoscopy in the incidence of postoperative pulmonary complications. METHODS Randomized clinical trial with 30 patients divided into control group (CG) and experimental group (EG), with analysis of spirometric, ventilatory, hemodynamic, and radiographic variables. ARM was performed in EG with positive end expiratory pressure of 30 cmH₂O and inspiratory plateau pressure of 45 cmH₂O for 2 minutes after pneumoperitoneum deflation. RESULTS We observed a significant decrease in spirometric values (p ≤ 0.001) and higher incidence of pulmonary complications on chest radiograph (p=0.02) in CG, as well as significant improvement in dyspnoea Borg scale (p ≤ 0.001) in EG. CONCLUSIONS We conclude that ARM is a safe and effective technique when used for prevention of pulmonary complications in patients undergoing bariatric surgery, resulting in more favorable radiological and spirometric findings in the experimental group compared to the control group in the PO.
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Affiliation(s)
- Paula Patelli Juliani Remístico
- Faculty of Medical Sciences, Universidade Estadual de Campinas Rua Tessália Vieira de Camargo, 126 Cidade Universitária "Zeferino Vaz" 13083-887, PO Box 6111-Campinas, SP, Brazil.
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Abstract
The increasing societal prevalence of obesity is consequential to the increasing number of critically ill obese patients. Vascular procedures are an essential aspect of care in these patients. This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed.
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Affiliation(s)
- Omar Rahman
- Adult Intensive Care/Shock Trauma Unit, Geisinger Medical Center, Danville, PA 17822, USA.
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Reply to Letter: Agreed: “PRAM May be Useful to Assess the Cardiovascular Changes in Obese Patients During Laparoscopy”. Obes Surg 2009. [DOI: 10.1007/s11695-008-9743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Forfori F, Romano SM, Balderi T, Anselmino M, Giunta F. Response to Dr. Bernstein's review: pressure pulse contour-derived stroke volume and cardiac output in the morbidly obese patient. Obes Surg 2008; 19:128-30, author reply 131-3. [PMID: 18946708 DOI: 10.1007/s11695-008-9745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 10/01/2008] [Indexed: 11/30/2022]
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Bernstein DP. Pressure Pulse Contour-derived Stroke Volume and Cardiac Output in the Morbidly Obese Patient. Obes Surg 2008; 18:1015-21. [DOI: 10.1007/s11695-007-9378-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/23/2007] [Indexed: 01/14/2023]
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Balderi T, Forfori F, Marra V, Di Salvo C, Dorigo M, Anselmino M, Romano SM, Giunta F. Continuous Hemodynamic Monitoring During Laparoscopic Gastric Bypass in Superobese Patients by Pressure Recording Analytical Method. Obes Surg 2008; 18:1007-14. [DOI: 10.1007/s11695-007-9379-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
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O'Hanlan KA, Dibble SL, Fisher DT. Total laparoscopic hysterectomy for uterine pathology: Impact of body mass index on outcomes. Gynecol Oncol 2006; 103:938-41. [PMID: 16828849 DOI: 10.1016/j.ygyno.2006.05.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 05/21/2006] [Accepted: 05/24/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to analyze surgical results of women with uterine cancers having TLH+/-staging, stratifying data by body mass index (BMI). METHODS This is a retrospective analysis of data from 9 years, using Pearson and Spearman correlations, ANOVA and Fisher's Exact Test with significance at P<0.05, stratifying by BMI (kg/m2): underweight (<18.5 kg/m2), ideal (18.5-24.9 kg/m2), overweight (25 to 29.9 kg/m2), obese (30 to 39.9 kg/m2) and morbidly obese (40 kg/m2 or more). RESULTS Of 702 patients having TLH over 9 years, 90 patients had uterine pathology. Two (2%) procedures were converted to laparotomy due to unsuspected widespread metastasis and excluded from analysis. BMI ranged from 18 to 60 kg/m2, with 31 patients having ideal, 19 having overweight and 38 having obese BMI. Of these, 19 patients had hyperplasia, while 63 had endometrial carcinoma, 1 had both ovarian and endometrial carcinoma and 5 had sarcoma. Of these 88 patients, 61 had TLH while 27 patients had indicated pelvic and aortic node dissection. The mean age was 60 years, and mean parity was 1.5 for all BMI groups. There were no significant differences in mean duration of surgery (150 min), blood loss (129 cm3) and days in hospital (1.7 days) for all BMI groups. There was no significant difference in uterine weight (140 gm) or number of nodes dissected (21 nodes). Complications occurred in 4 patients (4.5%): 1 diverticulitis, 1 ureteral injury, 1 laparotomy for bleeding and 1 incisional hernia. CONCLUSIONS Total laparoscopic hysterectomy is feasible and safe for women with uterine neoplasia for every BMI category and extends the benefits of minimally invasive hysterectomy to more women, regardless of BMI.
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Affiliation(s)
- Katherine A O'Hanlan
- Gynecologic Oncology Associates, 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, USA.
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Aloni Y, Evron S, Ezri T, Medalion B, Protianov M, Szmuk P, Zimlichman R, Muggia-Sullam M. Morbidly obese patients are hemodynamically stable during laparoscopic surgery: a thoracic bioimpedance study. J Clin Monit Comput 2006; 20:261-6. [PMID: 16791444 DOI: 10.1007/s10877-006-9034-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Morbid obesity caries an increased risk of cardiovascular morbidity and might be associated with intraoperative hemodynamic instability. Based on clinical observation, we hypothesized that during laparoscopic surgery, morbidly obese patients behave hemodynamically similar to the nonobese patients and remain hemodynamically stable. METHODS In a prospective trial, thirty nonobese and tthirty morbidly obese (BMI > or = 35 kg/m(2)) patients scheduled for elective laparoscopic surgery were assigned to receive standard balanced anesthesia. We aimed at equianesthetic levels by keeping the BIS (bispectral index) value between 40-50 throughout surgery. End-tidal isoflurane was measured every 5 min. Noninvasive hemodynamic measurements included cardiac index (CI), mean arterial pressure (MAP) and heart rate (HR), recorded every 5 min and at specific predetermined times. Systemic vascular resistance (SVR) was calculated. Episodes of MAP < or = 60 and MAP > or = 130 mmHg or HR < or = 50 and HR > or = 110 bpm occurring throughout surgery and requiring pharmacological intervention were considered main end-points. Additionally, hemodynamic variables were compared at specific time points and overall throughout surgery. Secondary end-points were CI and SVRI. RESULTS Heart rate was higher in obese patients in head-up position (79 +/- 15 mmHg vs. 65 +/- 12 mmHg - P=0.011). SVR was higher in the nonobese group with head-up position (1978 +/- 665 dynes s cm(-5) vs. 1394 +/- 496 dynes s cm(-5) P=0.01). Mean overall intraoperative MAP, HR, CI and SVR were similar. There were no episodes of MAP < or = 60 and > or =130 mmHg or HR < or = 50 and > or =110 bpm in either of the groups. CONCLUSION Our study confirmed our hypothesis that for the most periods of laparoscopic surgery, obese patients are hemodynamically as stable as their nonobese counterparts.
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Affiliation(s)
- Yoela Aloni
- Department of Surgery "B", The Edith Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv, Israel
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Horne AW, Sutherland S, Faratian D, Farquharson DIM, Duncan WC. Ovarian choriocarcinoma masquerading as ectopic pregnancy. J OBSTET GYNAECOL 2006; 26:385-7. [PMID: 16753708 DOI: 10.1080/01443610600635303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A W Horne
- Simpson Centre for Reproductive Health, UK.
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Ezri T, Muzikant G, Medalion B, Szmuk P, Charuzi I, Susmallian S. Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures. Int J Obes (Lond) 2004; 28:1157-62. [PMID: 15311219 DOI: 10.1038/sj.ijo.0802709] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
UNLABELLED Publications regarding anesthetic management for weight reduction surgery are scarce. We reviewed the records of 234 patients who underwent bariatric restrictive procedures (gastric bypass not included) from May 1999 to September 2000. Variables analyzed included demographics, anesthetic data and perioperative course. Patients were allocated into two groups: laparoscopic (LPG) and open procedures (OPG), comprising 167 and 67 patients respectively. Obstructive sleep apnea was present in 4.8% in LPG vs 6.1% in OPG. Awake fiberoptic intubation was performed in 3.6% in LPG and 1.5% in OPG. The other patients were anesthetized with rapid sequence induction (classic or modified). Grade III laryngoscopy was present in 6% in LPG and 7.1% in OPG. No intraoperative complications were encountered. Postoperative PACU follow-up time was similar. In both groups, i.v. meperidine was most frequently used for postoperative analgesia (in the PACU), as compared to the other analgesics employed (P<0.03). Early postoperative complications (prolonged mechanical ventilation, unplanned ICU admission, sepsis, re-operation) occurred more frequently in OPG, but the difference between the two groups was statistically insignificant (P<0.08). The length of hospitalization was 3.8+/-1.4 days in LPG and 6.2+/-6.6 in OPG (P<0.01). Mortality was zero. Anesthesia for restrictive bariatric surgery (both open and laparoscopic approaches) was associated with few complications. SUMMARY STATEMENT We reviewed the records of 234 patients who underwent restrictive bariatric procedures (gastric bypass not included) from May 1999 to September 2000, in regard to perioperative complications. Anesthesia was associated with no intraoperative and few postoperative complications.
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Affiliation(s)
- T Ezri
- Department of Anesthesia, the Edith Wolfson Medical Center, Holon, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel
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O'Hanlan KA, Huang GS, Lopez L, Garnier AC. Selective incorporation of total laparoscopic hysterectomy for adnexal pathology and body mass index. Gynecol Oncol 2004; 93:137-43. [PMID: 15047227 DOI: 10.1016/j.ygyno.2003.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We studied patients undergoing adnexectomy with total laparoscopic hysterectomy (TLH) for ovarian pathology, over a 6-year period. METHODS Chart abstraction, analyzed by ANOVA, Fisher's Exact Test with significance at P < 0.05, stratifying by body mass index (BMI, kg/m(2): ideal < 25; overweight 25-29.9; obese 30+). RESULTS Of 354 patients undergoing TLH, 90 cases had adnexal pathology: 69 complex masses, 16 BRCA1/2 mutations, 5 unstaged ovarian carcinomas; 48 having ideal BMI, 26 overweight, and 16 obese. Mean age (51 years) and parity (1.2 children) were similar between BMI groups. Thirty-four percent were nulliparous. All 90 underwent TLH, adnexectomy, washings; with 14 appendectomies, 5 lymphadenectomies, 3 node samplings, 6 omentectomies, 8 ureterolyses, and 1 Burch. Mean surgery duration (156 min), blood loss (152cc), and hospital stay (1.9 days) were similar across BMI groups. Mean nodal yield from each lymphadenectomy was 14, and 2.6 from sampling. Mean size of pelvic masses was 8 cm (range 3-19 cm). There were seven cases of ovarian carcinoma: 2 Stage IA, 1 IB, 2 IC, 1 IIC, 1 IIIB; 1 recurrent breast cancer, 16 adenofibromas, 15 endometriomas, 10 dermoids, and 41 serous/mucinous cystadenomas. Mean complication rate was 6.6% (ns): 1 seroma, 1 hematoma, 1 obstructive adhesions, and 3 urological injuries. All urological injuries were within the first third of patients. CONCLUSIONS TLH appears feasible for women with adnexal pathology regardless of BMI, in an oncological practice. This pilot data can facilitate guidelines for a randomized controlled trial of TLH with TAH and LAVH, and help surgeons avoid our early complications.
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OʼHanlan KA, Lopez L, Dibble SL, Garnier AC, Huang GS, Leuchtenberger M. Total Laparoscopic Hysterectomy. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200312000-00028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Casati A, Comotti L. A reply. Eur J Anaesthesiol 2000; 17:786-7. [PMID: 11122315 DOI: 10.1046/j.1365-2346.2000.00778.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Casati
- University of Milan - Department of Anaesthesiology, IRCCS H San Raffaele, Via Olgettina 60 - 20132, Milan, Italy
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Dumont L, Mardirosoff C. Effects of a pneumoperitoneum in the obese patient. Eur J Anaesthesiol 2000; 17:786-7. [PMID: 11122314 DOI: 10.1046/j.0265-0215.2000.00775.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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