Morbid Obesity: Peri-operative Management, Second Edition

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Preface to the Second Edition......Page 12
Preface to the First Edition......Page 13
Abbreviations......Page 15
1.2.2 Adiponectin......Page 19
1.2.3 Inflammatory adipokines......Page 20
1.2.10 Clinical implications......Page 21
1.3.3 Stroke volume and cardiac output......Page 22
1.4.2 Concentric hypertrophy......Page 24
1.4.4 Pathophysiologic considerations......Page 25
1.5.1 Diastolic dysfunction and diastolic heart failure......Page 26
1.5.4 Right ventricular dysfunction and failure: effects of BMI, obstructive sleep apnea, and pulmonary hypertension......Page 28
1.7.1 Atrial fibrillation......Page 29
1.7.2 Obstructive sleep apnea......Page 30
1.7.3 Hypertension and vascular compliance......Page 31
1.7.5 Coronary heart disease, atherogenesis, and the cardio-metabolic syndrome......Page 32
References......Page 33
2.2.1 Respiratory physiologic changes......Page 37
2.2.3 Obesity and asthma......Page 38
2.3.2 Definition of obstructive sleep apnea and polysomnography......Page 39
2.3.3 Pathophysiology of obstructive sleep apnea in obesity......Page 40
2.3.5 Treatment of obstructive sleep apnea......Page 41
2.3.7 Obstructive sleep apnea physiology in the peri-operative period......Page 42
2.4 Obesity hypoventilation syndrome......Page 43
References......Page 44
3.2 Non-alcoholic fatty liver disease......Page 46
3.2.1 Non-alcoholic fatty liver disease and type 2 diabetes......Page 47
3.3 Non-alcoholic steatohepatitis......Page 48
3.5 Fat distribution......Page 49
3.6 Metabolic syndrome......Page 50
3.6.2 MetS and cardiovascular risk......Page 52
3.6.3	Metabolic syndrome in the peri-operative period......Page 53
3.7 Peri-operative hyperglycemia......Page 55
3.8 Conclusions......Page 56
References......Page 57
4.2.1 Acidification......Page 62
4.3.1 Cardiovascular and hemodynamic effects of increased intra-abdominal pressure......Page 64
4.3.3 Renal effects......Page 65
4.3.5 Effects on regional blood flow......Page 66
4.4.4 Optimize volume status......Page 67
References......Page 68
5.2.1 Adjustable gastric band......Page 71
5.2.3 Biliopancreatic diversion......Page 72
5.3 Matching patient to procedure or procedure to patient......Page 73
5.6 Patient’s choice......Page 75
5.8.1 Degree of adiposity......Page 76
5.8.4 Underlying gastrointestinal disorders......Page 77
References......Page 78
6.2 History......Page 81
6.4.1 Intentionality......Page 82
6.4.3 Lack of controlling influences......Page 83
6.5 Physician beneficence......Page 84
6.6.1 The state courts......Page 85
6.6.2 Legislative approaches to informed consent......Page 86
6.8 Conclusions......Page 87
References......Page 89
7.2.2 History and physical examination......Page 90
7.2.2.2 Pulmonary......Page 92
7.2.2.6 Nutritional......Page 93
References......Page 94
8.3 Medical assessment......Page 97
8.4 Psychologic assessment......Page 98
8.5 Preparation......Page 99
References......Page 100
9.3 Supine position......Page 103
9.4 Head-up positions......Page 104
9.5 Head-down (Trendelenburg) position......Page 105
9.7 Lateral decubitus position......Page 106
9.10 Conclusions......Page 107
References......Page 108
10.3 Central venous pressure and pulmonary artery occluded pressure......Page 110
10.5 Electrocardiographic monitoring......Page 111
10.7 Transcutaneous oxygen tension monitoring......Page 112
10.10 Temperature monitoring......Page 113
10.11.2 Qualitative neuromuscular transmission monitoring and treatment: peripheral nerve stimulator......Page 114
10.13 Does monitoring improve mortality due to anesthesia?......Page 115
References......Page 116
11.2 Pharmacokinetics and pharmacodynamics of anesthetic agents in obese patients......Page 118
11.3.2 Ideal body weight and % ideal body weight......Page 119
11.3.7 Lean body weight......Page 120
11.4.1.1 Thiopental......Page 121
11.4.2.1 Fentanyl......Page 122
11.4.3 Mode of administration of hypnotics and opioids......Page 123
11.4.4.3 Sevoflurane......Page 124
11.4.5.4 Cisatracurium......Page 125
References......Page 126
12.2 Morbid obesity and difficult airway management – what is the risk?......Page 129
12.3 Airway anatomy in morbid obesity......Page 130
12.4.2 Pulmonary considerations......Page 132
12.5.2 Fastrach LMA......Page 133
12.6.1 Primary strategy: Direct laryngoscopy......Page 134
12.6.2.3 Rigid fiberoptic laryngoscopes......Page 135
12.6.2.6 McGrath® Videolaryngoscope (LMA North America Inc)......Page 136
12.6.2.9 Intubating (Fastrach™) LMA and C-Trach......Page 137
References......Page 138
13.2.1 Pneumoperitoneum and mechanics of breathing during laparoscopy......Page 142
13.3.1 Intra-operative arterial oxygen tension (PaO2)......Page 143
13.4.2 Association between mechanical ventilation and post-operative ventilator-associated lung injury......Page 144
13.5 Intra-operative ventilatory strategies for morbidly obese patients......Page 145
13.5.1.1 Ventilatory pressures during high-VT ventilation......Page 146
13.5.3 Strategy 3: Alveolar recruitment maneuvers......Page 147
13.5.5 Risks and benefits of alveolar recruitment maneuvers......Page 148
13.7 Assessment of recruitment using gas exchange......Page 149
13.8.3 Stress index monitoring......Page 150
13.9 Other measures that can minimize intra-operative atelectasis......Page 151
13.10 Summary of ventilation recommendations for obese patients......Page 152
References......Page 153
14.3 Neuraxial blocks......Page 156
14.3.1 Epidural anesthesia......Page 157
14.3.2 Spinal anesthesia......Page 158
14.4 Peripheral nerve blocks......Page 159
References......Page 160
15.2.1 Opioid analgesia......Page 162
15.2.7 Multimodal opioid analgesia......Page 163
15.3.2.1 Surgical site infusions......Page 164
15.4 Neuraxial post-operative pain management modalities......Page 165
15.6 Post-operative analgesia for obstructive sleep apnea and related syndromes......Page 167
15.8 Conclusions......Page 169
References......Page 170
16.2 Nausea and vomiting......Page 173
16.3 Airway and respiratory complications......Page 174
16.5 Neuropathy......Page 175
16.7 Acute hemorrhage......Page 176
References......Page 177
17.2.1 Cardiovascular aspects......Page 179
17.2.2 Pulmonary aspects......Page 180
17.2.3 Nutrition......Page 182
17.2.5 Pharmacology......Page 183
17.3.2 Anastomotic bleed......Page 185
17.3.3 Pulmonary embolism and deep vein thrombosis......Page 186
17.4 Conclusions......Page 187
References......Page 188
18.3 Rhabdomyolysis and morbid obesity......Page 191
18.4 Prevention of rhabdomyolysis......Page 193
18.5.2 Laboratory findings......Page 194
18.6 Treatment......Page 196
References......Page 198
19.3 Implementing competencies......Page 200
19.4 Peri-operative nursing care......Page 201
19.5 Nutritional support......Page 202
19.6 Empathy training and psychologic support......Page 203
References......Page 204
20.2.1 Incisional hernia......Page 206
20.2.3 Symptomatic gallstones......Page 207
20.3.1 Nutritional deficiency......Page 208
20.3.2.3 Staple-line disruption/gastrogastric fistula......Page 209
20.4.1 Band slippage......Page 210
20.4.3 Band erosion......Page 211
20.4.5 Esophageal/pouch dilatation......Page 212
References......Page 213
21.2 Nutritional deficiencies following bariatric surgery......Page 216
21.3 Complications of bariatric surgery......Page 221
21.4 Assessment and management......Page 222
References......Page 223
22.3 Outcomes: Weight loss......Page 226
22.4 Outcomes: Comorbidity resolution......Page 227
22.6 Outcomes: Complications......Page 228
22.8 Outcomes: Survival benefit......Page 229
References......Page 230
23.2.1 Pre-operative educational workshop......Page 234
23.2.2.3 Psychologist......Page 235
23.2.2.4 Dietician......Page 236
23.5 Operating room......Page 237
23.7 Infrastructure......Page 238
References......Page 239
24.4 Risk factors......Page 240
24.5.1.4 Musculoskeletal effects......Page 241
24.6 Psychosocial impact......Page 242
24.9 Surgical options......Page 243
24.10 Guidelines for bariatric surgery in adolescents......Page 244
24.11 Pre-operative evaluation......Page 245
24.14 Compliance......Page 246
24.16 Summary......Page 247
References......Page 248
25.3.1 Cardiovascular system......Page 251
25.3.2 Respiratory system......Page 252
25.5.1 General anesthesia......Page 253
25.5.2 Regional anesthesia and analgesia for labor......Page 254
References......Page 255
Index......Page 258