scholarly journals Laparoscopic Sleeve Gastrectomy in a Morbidly Obese Patient with Myasthenia Gravis: A Review of the Management

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Megana Ballal ◽  
Tracey Straker
Keyword(s):  
Myasthenia Gravis ◽  
Obese Woman ◽  
Anesthetic Management ◽  
Surgical Techniques ◽  
Morbidly Obese ◽  
Unique Challenge ◽  
Reversal Agents ◽  
Morbidly Obese Patient ◽  
Perioperative Risks ◽  
Postoperative Mechanical Ventilation

Myasthenia gravis, a disorder of neuromuscular transmission, presents a unique challenge to the perioperative anesthetic management of morbidly obese patients. This report describes the case of a 27-year-old morbidly obese woman with a past medical history significant for myasthenia gravis and fatty liver disease undergoing bariatric surgery. Anesthesia was induced with intravenous agents and maintained with an inhalational and balanced intravenous technique. The nondepolarizing neuromuscular blocker Cisatracurium was chosen so that no reversal agents were given. Neostigmine was not used to antagonize the effects of Cisatracurium. The goal of this approach was to reduce the risk of complications such as postoperative mechanical ventilation. The anesthetic and surgical techniques used resulted in an uneventful hospital course. Therefore, we can minimize perioperative risks and complications by adjusting the anesthetic plan based on the patient’s physiology and comorbidities as well as the pharmacology of the drugs.

scholarly journals Anesthetic management of a morbidly obese patient with endometrial cancer during robot-assisted laparoscopic surgery

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yusuke Ishida ◽  
Koichi Nakazawa ◽  
Toshio Okada ◽  
Yumi Tsuzuki ◽  
Takayuki Kobayashi ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Obese Woman ◽  
Anesthetic Management ◽  
Laparoscopic Hysterectomy ◽  
Lung Protective Ventilation ◽  
Morbidly Obese ◽  
Anesthesia Induction ◽  
Robot Assisted ◽  
Morbidly Obese Patient ◽  
Respiratory Management

Abstract Background The number of robot-assisted surgeries being performed has increased in recent years, even in patients with risk factors, such as obesity, owing to advancements in medical technologies. We here report the anesthetic management of a morbidly obese woman who underwent robot-assisted surgery. Case presentation A 44-year-old woman (height, 165 cm; weight, 147 kg; body mass index, 54 kg/m2) was scheduled to undergo robot-assisted laparoscopic hysterectomy for endometrial cancer. Preoperative weight loss and rehearsal of positioning during induction of anesthesia and surgical procedures greatly contributed to the surgical success. Monitoring of oxygen reserve index in combination with SpO2 was useful for appropriate airway and respiratory management. During anesthesia induction, the ramp position using a special commercially available cushion facilitated manual mask ventilation and tracheal intubation. Lung-protective ventilation using a limited tidal volume with moderate PEEP was applied during the robot-assisted surgical procedure. Conclusion We successfully managed anesthesia without any complications.

scholarly journals Case Report of a Massive Thigh Hematoma after Adductor Canal Block in a Morbidly Obese Woman Anticoagulated with Apixaban

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Katherine L. Koniuch ◽  
Bradley Harris ◽  
Michael J. Buys ◽  
Adam W. Meier
Keyword(s):  
Early Recognition ◽  
Obese Woman ◽  
Rare Event ◽  
Morbidly Obese ◽  
Adductor Canal Block ◽  
Nerve Blocks ◽  
Adductor Canal ◽  
Morbidly Obese Patient ◽  
Anterolateral Thigh ◽  
Anticoagulated Patient

Hematoma formation after peripheral nerve block placement is a rare event. We report a case of a morbidly obese patient who was anticoagulated with apixaban and developed a massive thigh hematoma after an ultrasound-guided adductor canal block. Despite continuous visualization of the block needle, an unrecognized vascular injury occurred leading to a 14-cm hematoma in the anterolateral thigh. Morbid obesity warrants additional risk consideration when placing nerve blocks in an anticoagulated patient. In addition, early recognition and expert consultation are both important in the management of block-related hematomas.

scholarly journals Knee Dislocation of a Morbidly Obese Patient: A Case Report

2005 ◽  
Vol 13 (1) ◽  
pp. 76-78 ◽  
Author(s):  
RR Shetty ◽  
SB Mostofi ◽  
PL Housden
Keyword(s):  
Closed Reduction ◽  
Obese Woman ◽  
Weight Bearing ◽  
Knee Dislocation ◽  
Foot Drop ◽  
Morbidly Obese ◽  
Morbidly Obese Patient ◽  
Valgus Instability ◽  
Foot Function ◽  
The Right

Knee dislocations of morbidly obese patients after a trivial fall are not uncommon. We report a case of closed reduction for a dislocated right knee of a 26-year-old obese woman. After closed reduction under general anaesthesia, her knee was supported by pillows in 30 degrees flexion. No external splint was used because of the enormous size of the leg. At day 4 after reduction, the patient had numbness over the dorsum of the right foot and was unable to dorsiflex. She was diagnosed as having peroneal nerve palsy and was fitted with a foot drop splint. One week after reduction, she started active, assisted knee mobilisation and tip-toe weight bearing. At 24 months after reduction, the patient was able to walk unaided and had 100 degrees of knee flexion. She had a good foot function and a grade II in the Lachman's test, with no varus or valgus instability. This case highlights the importance of early mobilisation, which can result in good outcome even without operative treatment.

scholarly journals Comparison of General and Regional Anesthesia in Morbidly Obese Patient: Case Report

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Obese Patient ◽  
Spinal Anesthesia ◽  
Clinical Course ◽  
Obese Woman ◽  
Laser Lithotripsy ◽  
Morbidly Obese ◽  
Flexible Ureterorenoscopy ◽  
Diabetes Mellitus Type Ii ◽  
Morbidly Obese Patient ◽  
History Of

Obese patients and weight related health problems represent a great challenge for modern anesthesiologists to find most adequate and optimal anesthesiology technique. We would like to present a case of morbidly obese patient scheduled for flexible ureterorenoscopy and laser lithotripsy operation as treatment for nephrolithiasis at our urology clinic. Patient was a morbidly obese woman with BMI of 57 kg/m2 , with history of asthma; diabetes mellitus type II, arterial hypertension and hypothyreosis. Our case is specific because this patient had the same operation twice in two month period, first operation was done in general endotracheal anesthesia, and second one in regional spinal anesthesia. We show the preoperative, intraoperative and postoperative clinical course of the patient for both anesthesias. Patient clinical course was much better and she spent less time in hospital with spinal anesthesia. We think that spinal anesthesia would be a better choice in morbidly obese patient, off course, taking in to account indications and contraindications for it.

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