Considerations for Potential Older Kidney Transplant Candidates with Obesity

Current Transplantation Reports, Год журнала: 2025, Номер 12(1)

Опубликована: Янв. 24, 2025

Язык: Английский

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Justification of Body Mass Index cutoffs for hip and knee joint arthroplasty among California orthopedic surgeons

Journal of Orthopaedic Surgery and Research, Год журнала: 2025, Номер 20(1)

Опубликована: Янв. 31, 2025

Many orthopedic surgeons choose not to perform joint arthroplasty on patients with a Body Mass Index (BMI) of 35 or above, citing poorer outcomes and increased procedure risk. Identifying addressing factors use determine BMI cutoffs are necessary increase access orthopaedic care for this growing patient population. This will help reduce healthcare disparities while also identifying clinical facilities, equipment, training, procedures that require improvements accommodate larger individuals. Orthopaedic were surveyed identify surgeon-specific hip knee arthroplasty. The survey was circulated within the California Association (COA) report during March 2023. Questions aimed justifications such as infection risk, co-morbidities, inadequate American Academy Surgeons (AAOS) guidelines. Data decision making about exceptions collected. 75% respondents 91% indicated they either wholly partially responsible setting cutoffs. Mean 40.5 41, respectively. Four categories cutoff identified: (1) risk complications; (2) surgery logistics; (3) concerns facilities resources; (4) surgeon perception. BMI-based denial define key addressable areas improvement can life-changing surgeries THA TKA. Insight from queried drive future research address need.

Язык: Английский

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Multimodal Prehabilitation for Gynecologic Cancer Surgery

Current Oncology, Год журнала: 2025, Номер 32(2), С. 109 - 109

Опубликована: Фев. 14, 2025

Surgical treatment is commonly employed to treat patients with gynecologic cancer, although surgery itself may function as a stressor, reducing the patients' functional capacity and recovery. Prehabilitation programs attempt improve overall health baseline prior surgery, thereby enhancing recovery lowering morbidity. In recent years, prehabilitation has come primarily refer multimodal that combine physical activity, nutritional support, psychological well-being, other medical interventions. However, specific methods of implementing measuring its effectiveness are heterogeneous. Moreover, high-level evidence regarding in cancer limited. This review provides summary studies oncologic surgery. Enhanced postoperative recovery, lower complications, rate blood transfusions, faster gastrointestinal have been reported after Patients healthcare professionals should recognize importance field treatment, based on emerging evidence. addition, there need establish an appropriate target group construct well-designed tailored program.

Язык: Английский

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Comparison of remimazolam-based and propofol-based general anaesthesia on postoperative quality of recovery in patients undergoing laparoscopic sleeve gastrectomy: protocol for a prospective, randomised, parallel-group, non-inferiority trial

BMJ Open, Год журнала: 2025, Номер 15(2), С. e093144 - e093144

Опубликована: Фев. 1, 2025

Introduction Remimazolam is a novel short-acting benzodiazepine that exhibits sedative and hypnotic properties without compromising respiratory function while maintaining haemodynamic stability. Its safety efficacy have been demonstrated to be non-inferior those of propofol in the context general anaesthesia. Nevertheless, non-inferiority terms postoperative recovery quality obese patients has not established. Thus, we conducted prospective, randomised, parallel-group, study compare remimazolam-based anaesthesia with propofol-based on (QoR) undergoing laparoscopic sleeve gastrectomy. Methods analysis All participants meeting included criteria will enrolled after signing an informed consent form. Patients randomly allocated either group (n=63; induction maintenance propofol) or remimazolam remimazolam). The primary endpoint 15-item QoR Scale assessed at 24 hours postoperatively. Secondary endpoints include doses anaesthetic required for loss consciousness (LOC), time LOC, consciousness, total amount administered during surgery incidence hypotension bradycardia. Additionally, profiles pain, nausea vomiting, delirium, intraoperative awareness, adverse events patient satisfaction collected. Statistical analyses performed using IBM SPSS Statistics V.26.0 GraphPad Prism V.5.01. significance set two-sided p values<0.05. Ethics dissemination Ethical approval was obtained from ethics committees Beijing Chaoyang Hospital, Capital Medical University (No. 2023ke715-1). findings disseminated peer-reviewed publications. Trial registration number ChiCTR2400083700.

Язык: Английский

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Risk factors for extubation-related complications in morbidly obese patients undergoing bariatric surgery: a retrospective cohort study

Journal of Anesthesia, Год журнала: 2025, Номер unknown

Опубликована: Март 28, 2025

Abstract Background One-third of major anesthesia-related airway complications occur during or shortly after tracheal extubation. Obesity significantly impacts respiratory function and is a key contributor to morbidity mortality. Patients with morbid obesity often require bariatric surgery. However, extubation-related in this specific surgical population have not been previously studied. This study aimed determine the rate frequency extubation patients undergoing surgery associated risk factors for these complications. Materials methods was retrospective cohort adult above 18 years age body mass index ≥ 40 kg/m 2 who underwent between June 2016 2024. Extubation-related were defined as occurrence any following: vomiting, aspiration, laryngospasm, bronchospasm, cardiovascular instability, edema, desaturation (SpO < 90%), need rescue device reintubation Logistic regression analysis, adjusted sex, performed evaluate associations. The significance level by applying Bonferroni correction (0.05/16 = 0.0031), p -value 0.0031 interpreted statistically significant. Results Data from 1193 analyzed. overall complication 4.4%, most frequent being desaturation, which occurred 3.2% patients. analysis showed that odds increased twofold obese 50–59 (odds ratio [OR] 1.97, 95% confidence interval [95%CI] 0.99–3.94, 0.055) threefold > 60 (OR 2.95, 95%CI 0.99–8.81, 0.05). commonly comorbidities hypertension obstructive sleep apnea, an 2.98 2.15 apnea (95%CI 1.40–6.33, 0.005; 1.08–4.29, 0.03; respectively). Despite clinically important results, correction, none associations remain significant, corrected p-values are threshold 0.0031. Conclusion identified common post-extubation morbidly Moreover, we found increasing classes, particularly , well apnea. These findings suggest importance tailored strategies close perioperative monitoring mitigate risks.

Язык: Английский

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Effects of Different Ventilation Modes on Intracranial Pressure and Carbon Dioxide Partial Pressure during Bariatric Surgery: a Prospective, Randomized, Controlled Study

Research Square (Research Square), Год журнала: 2024, Номер unknown

Опубликована: Сен. 8, 2024

Background Obesity is linked to the retention of carbon dioxide, headaches, and idiopathic intracranial hypertension. Although studies indicate that different ventilation modalities may change pressure dioxide partial pressure, their impact on bariatric surgery patients remains unclear. This study aimed monitor, compare, analyze respiratory mechanics, under three modes: control (PC), volume (VC), pressure-regulated (PRVC) during explore clinical significance value PRVC mode. Methods was a prospective, randomized, controlled study. Ninety who underwent were randomly randomized into groups: Group I utilized II used III (PRVC). Measurements obtained at five time points: before pneumoperitoneum (T1), 5 minutes after (T2), 10 (T3), 15 (T4), 20 (T5). The collected parameters included: (ICP, measured through optic nerve sheath diameter [ONSD]), esophageal (PES), average airway (PAWM), peak (PAP), arterial (PaCO₂), end-tidal concentration or (ETCO₂), tidal (TV), mean (MAP, calculated as MAP = diastolic + 1/3 pulse difference), heart rate (HR). Results In all breathing modes, induced various degrees increase in ONSD, PAWM, PAP, PES. There no significant differences PAWM among groups any point (P > 0.05). However, PES much higher VC mode following than PC modes. Compared other two groups, TV considerably lower group < PaCO₂ ETCO₂ increased pneumoperitoneum, resulting increases MAP, HR (P < 0.05), but showed changes > Conclusion results this demonstrate can successfully prevent ICP, caused by pneumoperitoneum. It also prevents abnormal fluctuations surgery, ensuring stability patient's vital signs perioperative period. Therefore, ideal for laparoscopic surgery. Additionally, ONSD ultrasound assessment, noninvasive method evaluating be safely employed

Язык: Английский

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Anesthesiologists Cross the Quality Chasm with Point of Care Ultrasound (POCUS) Among Perioperative Patients

Anesthesia Research, Год журнала: 2024, Номер 1(3), С. 213 - 226

Опубликована: Дек. 6, 2024

Background/Objective: POCUS is an invaluable tool for anatomical variation assessment, guidance of invasive interventions, and diagnosis critical conditions that may change the anesthesiologist’s plan care. This technology increases success rate, decreases time to surgery, maximizes outcomes. The objective this pilot program evaluation was identify anesthesiologists’ systems processes utilizing in clinical decision-making patients during perioperative phases care improved Materials/Methods: A Multivariate Analysis Variance (MANOVA) conducted differences across groups (scan type). independent variable type examination. dependent variables included patient’s: (1) Perioperative Status; (2) Cardiothoracic Anesthesiologist’s Review Patient History Formulating Clinical Question; (3) Overall Risk Potential; (4) Aspiration (5) Issues Related Cardiovascular Hemodynamics; (6) Volume (7) Question Answered by POCUS; (8) Change Plan Care; (9) Interventions; (10) Pharmacological Interventions. Results: MANOVA findings (Wilks’ λ) identified a statistically significant interaction between scan cardiothoracic (p < 0.0001). following four criteria were significant: (64%) examined with preoperatively 0.05); (95%) as having some overall risk potential (36%) specifically aspiration 0.0001); (41%) issues related cardiovascular hemodynamics 0.001). Conclusions: proven imaging modality easy, portable, sensitive, specific identifying various landmarks. utilization setting has have profound impact on successful surgical completion.

Язык: Английский

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Mid-term Comparison of Weight Loss and Nutritional Parameters After Laparoscopic Sleeve Gastrectomy and Roux-En-Y Gastric Bypass

Kafkas Journal of Medical Sciences, Год журнала: 2021, Номер 11(3), С. 376 - 380

Опубликована: Янв. 1, 2021

Aim: In treating obesity, the restrictive effects of laparoscopic sleeve gastrectomy (LSG) and malabsorptive Roux-En-Y Gastric Bypass (LRYGB) are two distinct outcomes responsible for excess weight loss. Material Method:The data 110 patients who underwent bariatric surgery morbid obesity (Body Mass Index-BMI ≥40 kg/m 2 ) in our hospital between 2012 2017 completed 6-month follow-up period were retrospectively evaluated.According to surgical procedure (LSG LRYGB), divided into groups, with 65 LSG group 45 LRYGB group.The demographic characteristics both preoperative postoperative weight, BMI, iron, iron-binding capacity, ferritin, vitamin B12, folic acid, hemoglobin, 25-hydroxy D, MCV levels compared.Results: There was no significant difference groups regarding or BMI values loss at 6th month (p>0.05).While all parameters similar operation a decrease serum iron statistically (p=0.014,p=0.031, respectively).Conclusion: operations can be accepted as effective methods mid-term results success rates.Iron deficiency related blood count changes seen more frequently gastric bypass than those undergoing gastrectomy.

Язык: Английский

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