Anaesthetic Management of a Super Morbid Obese Patient

2021 ◽  
Vol 8 (32) ◽  
pp. 3039-3042
Author(s):  
Lekshmi Raj Jalaja ◽  
Stuti Lohia ◽  
Priyadarsini Bentur ◽  
Ravi Ramgiri
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Recovery Period ◽  
Well Being ◽  
Anaesthetic Management ◽  
The Body ◽  
World Health ◽  
Morbidly Obese ◽  
Multisystem Disorder ◽  
Increased Risk

‘Obesity’ is defined as a condition with excess body fat to the extent that health and well-being are adversely affected and uses a class system based on the body mass index (BMI), by the world health organization (WHO). Anaesthetic management of morbidly obese is challenging, as there is an increased risk of perioperative respiratory insufficiency and supplemental oxygen must be given throughout recovery period. The incidence of morbid obesity continues to grow and anaesthesiologists are exposed to obese patients presenting for various procedures. The prevalence of obesity is on the upward trend worldwide. Obesity is a multisystem disorder, involving the respiratory and cardiovascular systems, and therefore, undergoing a surgical procedure under anaesthesia may entail a considerable risk. Thus, a multidisciplinary approach is required in treating such patients. Quantification of the extent of obesity is done using the body mass index. BMI is defined as the relationship between weight and height (weight [kg] / height2 [m2 ]).

scholarly journals Prevalence and Psychosocial Determinants of Body Mass Index in Adult Population within a National Community Sample

2021 ◽  
Vol 04 (09) ◽  
Author(s):  
Zeynep Gamze Kalkanlı ◽  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Psychological Factors ◽  
Well Being ◽  
Overweight And Obesity ◽  
Brief Symptom Inventory ◽  
The Body ◽  
World Health ◽  
Sociodemographic Characteristics ◽  
Obesity And Overweight

Studies conducted by the World Health Organization (WHO) and Economic Development and Cooperation Organization (OECD) has shown that the prevalence of obesity is increasing worldwide and has become a serious health problem. The Body Mass Index (BMI), which is a commonly used height-weight index to classify overweight and obesity, is calculated by dividing body weight by the square of height (kg/m²). Psychological factors and sociodemographic characteristics are supposed to affect BMI under current living conditions. The aim of the study was to investigate the relationship between BMI, used in the classification of obesity, sociodemographic characteristics, and various psychological factors in adult. A total of 5,902 individuals (aged 39 and over) completed Sociodemographic Information Form, Body Mass Index Evaluation Form, and Experiences in Close Relationships Scale-Revised, Brief Symptom Inventory, Toronto Alexithymia Scale, Positive and Negative Affect Scale, Personal Well-Being Index-Adult Form. Utilizing hierarchical regression analysis, obesity and overweight were associated with educational status, number of cigarettes, number of children, negative self in both genders. Obesity and overweight were also associated withpsychiatric distress, alexithymia, and avoidant attachment scores in men. Obesity and overweight were associatedalso with alcohol use, somatization, and positive affect score in women. The results of the study reveal the importance of understanding the factors affecting obesity and addresses the problems in a multidimensional way. However, more studies are needed to better understand the factors associated with obesity in Turkey.

scholarly journals The Association of Obesity and Liver Enzyme Activities in a Student Population at Increased Risk for Cardiovascular Disease / Veza Između Gojaznosti I Aktivnosti Jetrenih Enzima U Studentskoj Populaciji Sa Povećanim Rizikom Za Nastanak Kardiovaskularnih Bolesti

2013 ◽  
Vol 32 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Emina Čolak ◽  
Dragana Pap ◽  
Nada Majkić-Singh ◽  
Ivana Obradović
Keyword(s):  
Body Mass Index ◽  
Waist Circumference ◽  
Liver Enzyme ◽  
Body Mass ◽  
Statistical Processing ◽  
The Body ◽  
Control Group ◽  
Anthropometric Parameters ◽  
Nonalcoholic Fatty Liver ◽  
Increased Risk

Summary Background: It has been reported that obesity is associated with metabolic syndrome, insulin resistance, cardiovascular risk but also with nonalcoholic fatty liver disease (NAFLD). The prevalence of obesity in children and adolescents is increasing rapidly all over the world. The aim of this study was to analyze the value of liver enzymes: AST, ALT and γGT in a group of obese students in order to establish their correlation to anthropometric parameters such as: BMI (body mass index), WC (waist circumference), HC (hip circumference), and WHR (waist-to-hip ratio) compared to non-obese students who comprised the control group (CG). Methods: In this study, 238 students from the University of Novi Sad of both sexes (126 men and 112 women) with a mean age of 22.32 ± 1.85 years were included. According to the body mass index (BMI) lower and higher than 25 kg/m2 and waist circumference (WC) lower and higher than 94 cm (80 cm for females) the whole group of 238 students was divided into 2 subgroups: the obese group at increased risk for CVD (Group 1) and the group at lower risk for CVD (Group 2). AST, ALT and γGT activities were determined in fasting blood samples. Results: Statistical processing data revealed significantly higher values of AST, ALT and γGT in the group of students with BMI>25 kg/m2, WC>94 cm for males and WC>80 cm for females, HC>108 cm for males and HC>111 cm for females, and WHR>0.90 for males and WHR>0.80 for females (P<0.001). Significant association was established between anthropometric parameters and liver enzyme levels (P<0.0001). Conclusions: Obese students with higher BMI, WC, HC and WHR values have higher liver enzyme activites and a higher chance to develop NAFLD in the future.

scholarly journals Correlation of Prolonged Total Ischemic Time with Body Mass Index in Kidney Transplant: A Single Center Report

2021 ◽  
Vol 5 (11) ◽  
pp. 1009-1013
Author(s):  
Eriawan Agung Nugroho ◽  
Erwin Wibowo ◽  
Prathita Amanda Aryani
Keyword(s):  
Body Mass Index ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Body Mass ◽  
The Body ◽  
Health Concern ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Ischemic Time ◽  
Increased Risk

Background: Chronic kidney disease (CKD) is a rising health concern worldwide, especially in Indonesia. The treatment of choice for end-stage renal disease is Kidney Transplantation.1 Numerous studies showed that prolonged total ischemic ischemic time may cause hypoxia of the graft tissue and increased risk of ischemia and reperfusion injury (IRI) and delayed graft function (DGF).2 Body mass index of kidney transplant recipients may cause prolonged duration of the procedure, as well as prolonged total ischemic time. This study aimed to determine the correlation between prolonged total ischemic time with body mass index. Method: This was an observational and cross-sectional analysis at Kariadi General Hospital Semarang involving patients who underwent kidney transplantation from January 2016 to December 2019. The total ischemic time was recorded intraoperatively. The Body Mass Index data were provided by medical records. The program used to statistically analyze the data was SPSS 23.0, and Spearman was used for hypothesis testing. Result: This study included 25 kidney transplant recipients. The mean total ischemic time was 43,27 ± 6,63 minutes. There was a significant positive correlation between prolonged ischemic time and body mass index (r= 0,506 ; p= 0,010). Conclusion: Prolonged total ischemic time was positively correlated with increased body mass index and these results are statistically significant.

scholarly journals Frequency of Genital Infections According to Body Mass Index in Dapagliflozin-treated Patients with Type 2 Diabetes Mellitus

2017 ◽  
Vol 04 (01) ◽  
pp. e1-e4
Author(s):  
Gottfried Rudofsky ◽  
Tanja Haenni ◽  
John Xu ◽  
Eva Johnsson
Keyword(s):  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Body Mass ◽  
The Body ◽  
Baseline Body Mass Index ◽  
Obese Patients ◽  
Genital Infections ◽  
Increased Risk ◽  
Three Body

Abstract Genital infections are associated with sodium glucose co-transporter 2 inhibitors such as dapagliflozin. Since patients with Type 2 diabetes are at increased risk of genital infections, and obesity is a risk factor for infections, obese patients with Type 2 diabetes could be more susceptible to genital infections when treated with sodium glucose co-transporter 2 inhibitors. This pooled dataset assessed the frequency of genital infections according to baseline body mass index in patients treated with dapagliflozin 10 mg. Data were pooled from 13 studies of up to 24 weeks’ duration (dapagliflozin N=2 360; placebo N=2 295). Frequency of genital infections was compared between three body mass index subgroups (<30, ≥30−< 35 and ≥35 kg/m2). Genital infections were reported in 130 (5.5%) patients receiving dapagliflozin and 14 (0.6%) patients receiving placebo; none of which were serious. Genital infections were more common in women (84/130 [64.6%]) than in men (46/130 [35.4%]) treated with dapagliflozin. In the body mass index < 30, ≥ 30−< 35 and ≥ 35 kg/m2 dapagliflozin-treated subgroups, 38/882 (4.3%), 47/796 (5.9%) and 45/682 (6.6%) patients presented with genital infections, respectively. Although the frequency was low overall and relatively similar between subgroups, there was a trend towards an increase in genital infections in patients with a higher body mass index. This trend is unlikely to be clinically relevant or to affect suitability of dapagliflozin as a treatment option for obese patients with Type 2 diabetes, but rather should influence advice and counselling of overweight patients on prevention and treatment of genital infections.

Anaesthesia for the obese patient

2017 ◽  
Author(s):  
Frédérique S. Servin ◽  
Valérie Billard
Keyword(s):  
Body Mass ◽  
Elective Surgery ◽  
Rapid Sequence Induction ◽  
Total Body Weight ◽  
Blocking Agent ◽  
Anaesthetic Management ◽  
Neuromuscular Blocking ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Increased Risk

Obesity is becoming an epidemic health problem, and the number of surgical patients with a body mass index of more than 50 kg m−2 requiring anaesthesia is increasing. Obesity is associated with physiopathological changes such as metabolic syndrome, cardiovascular disorders, or sleep apnoea syndrome, most of which improve with weight loss. Regarding pharmacokinetics, volumes of distribution are increased for both lipophilic and hydrophilic drugs. Consequently, doses should be adjusted to total body weight (propofol for maintenance, succinylcholine, vancomycin), or lean body mass (remifentanil, non-depolarizing neuromuscular blocking agent). For all drugs, titration based on monitoring of effects is recommended. To minimize recovery delays, drugs with a rapid offset of action such as remifentanil and desflurane are preferable. Poor tolerance to apnoea with early hypoxaemia and atelectasis warrant rapid sequence induction and protective ventilation. Careful positioning will prevent pressure injuries and minimize rhabdomyolysis which are frequent. Because of an increased risk of pulmonary embolism, multimodal prevention is mandatory. Regional anaesthesia, albeit technically difficult, is beneficial in obese patients to treat postoperative pain and improve rehabilitation. Maximizing the safety of anaesthesia for morbidly obese patients requires a good knowledge of the physiopathology of obesity and great attention to detail in planning and executing anaesthetic management. Even in elective surgery, many cases can be technical challenges and only a step-by-step approach to the avoidance of potential adverse events will result in the optimal outcome.

scholarly journals Perception of Body Image and Dietary Habit Among Adults Aged 20–45 Years at Sunyani Metropolis

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 277-277
Author(s):  
Jacob Setorglo ◽  
Philip Narteh Gorleku ◽  
Kyei Roselyn ◽  
Kingsley Kwadwo Asare Pereko
Keyword(s):  
Body Mass Index ◽  
Body Image ◽  
Body Size ◽  
Body Mass ◽  
Who Classification ◽  
The Body ◽  
World Health ◽  
Outcome Variable ◽  
Sugar Consumption ◽  
Normal Body

Abstract Objectives The study assessed the body size perception of respondents against the WHO body mass index and related the body sizes to fat and sugar consumption among 20–45-year-old adults. Methods The study design was a descriptive cross-sectional survey which involved 200 respondents aged 20–45 years, sampled conveniently. at Sunyani. Data on socio-demographic, fat and sugar consumption, anthropometry (weight in kg, height in cm) were collected. The weight and height data were later converted into body mass index using the World Health Organisation (WHO) classification. Sugar and fat intakes were measured by dietary food based assessment. (Analysis was done using IBM SPSS version 25. Proportions were presented for categorical values. Chi square test of association was used to determine relationship between the independent and the dependent outcome variable. Statistical significant was set at and P &lt; 0.05. Results The mean age of the respondents was 35 years. About 35.0% of respondents were males and the rest 65.0% females. Sugar and fat consumption among the respondents were within the recommended dietary allowances. Although 75% of respondents had normal body mass index (kg/m2) and 21% were obese based on the WHO classification, Majority (43.0%) of them perceived their body weights were normal. About 48.1% perceived they are either obese or had normal body size. There was no statistically significant association between respondents’ perceived body image and socio-demographic characteristics except for marital status (X2 = 8.82, P = 0.044). There was no statistically significant association between body image perception and dietary intake of fat and sugar. Conclusions There is great disparity in the perception of respondents body image compared to the WHO classification and married women and men are more particular about how they look. Dietary components studied do not have any association with body image. Funding Sources None.

Children Exposed or Unexposed to Human Immunodeficiency Virus: Weight, Height, and Body Mass Index During the First 5 Years of Life—A Danish Nationwide Cohort

2019 ◽  
Vol 70 (10) ◽  
pp. 2168-2177
Author(s):  
Ellen Moseholm ◽  
Marie Helleberg ◽  
Håkon Sandholdt ◽  
Terese L Katzenstein ◽  
Merete Storgaard ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Well Being ◽  
World Health ◽  
Control Group ◽  
Growth Chart ◽  
Significant Difference ◽  
Negative Effect ◽  
Z Scores ◽  
Health Organization

Abstract Background Exposures to human immunodeficiency (HIV) and antiretroviral therapy in utero may have adverse effects on infant growth. Among children born in Denmark and aged 0–5 years, we aimed to compare anthropometric outcomes in HIV-exposed but uninfected (HEU) children with those in children not exposed to HIV. Methods In a nationwide register-based study we included all singleton HEU children born in Denmark in 2000–2016. HEU children were individually matched by child sex, parity, and maternal place of birth to 5 singleton controls born to mothers without HIV. Weight-for-age z (WAZ) scores, length-for-age z (LAZ) scores, and weight-for-length or body mass index–for–age z scores were generated according to the World Health Organization standards and the Fenton growth chart for premature infants. Differences in mean z scores were analyzed using linear mixed models, both univariate and adjusted for social and maternal factors. Results In total, 485 HEU children and 2495 HIV-unexposed controls were included. Compared with controls, HEU children were smaller at birth, with an adjusted difference in mean WAZ and LAZ scores of −0.29 (95% confidence interval [CI], −.46 to −.12) and −0.51 (95% CI, −.71 to −.31), respectively (both P ≤ .001). Over time, there was a trend toward increasing WAZ and LAZ scores in HEU children, and there was no significant difference in adjusted WAZ scores after age 14 days (−0.13 [95% CI, −.27 to .01]; P = .07) and LAZ scores after age 6 months (−0.15 [95% CI, −.32 to .02]; P = .08). Conclusion Compared with a matched control group, HEU children were smaller at birth, but this difference decreased with time and is not considered to have a negative effect on the health and well-being of HEU children during early childhood.

scholarly journals Does Body Mass Index Affect Mortality in Coronary Surgery?

2016 ◽  
Vol 10 (1) ◽  
pp. 240-245 ◽  
Author(s):  
Aristotle D. Protopapas
Keyword(s):  
Body Mass Index ◽  
Morbid Obesity ◽  
Body Mass ◽  
Artery Bypass ◽  
Normal Weight ◽  
The Body ◽  
Morbidly Obese ◽  
Coronary Surgery ◽  
Crude Mortality ◽  
Underweight Patients

Introduction: The Body Mass Index (BMI) quantifies nutritional status and classifies humans as underweight, of normal weight, overweight, mildly obese, moderately obese or morbidly obese. Obesity is the excessive accumulation of fat, defined as BMI higher than 30 kg/m2. Obesity is widely accepted to complicate anaesthesia and surgery, being a risk factor for mediastinitis after coronary artery bypass grafting (CABG). We sought the evidence on operative mortality of CABG between standard BMI groups. Materials and Methodology: A simple literature review of papers presenting the mortality of CABG by BMI group: Underweight (BMI ≤ 18.49 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2), mild obesity (BMI 30.0–34.9 kg/m2), moderate obesity (BMI 35.0–39.9 kg/m2), or morbid obesity (BMI ≥ 40.0 kg/m2). Results: We identified 18 relevant studies with 1,027,711 patients in total. Their variability in size of samples and choice of BMI groups precluded us from attempting inferential statistics. The overall cumulative mortality was 2.7%. Underweight patients had by far the highest mortality (6.6%). Overweight patients had the lowest group mortality (2.1%). The group mortality for morbidly obese patients was 3.44%. Discussion: Patients with extreme BMI’s undergoing CABG (underweight ones more than morbidly obese) suffer increased crude mortality. This simple observation indicates that under nutrition and morbid obesity need be further explored as risk factors for coronary surgery.

scholarly journals Clinical verification of body mass index and tumor immune response in patients with breast cancer receiving preoperative chemotherapy

2021 ◽  
Author(s):  
Koji Takada ◽  
Shinichiro Kashiwagi ◽  
Yuka Asano ◽  
Wataru Goto ◽  
Rika Kouhashi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Preoperative Chemotherapy ◽  
Early Stage ◽  
The Body ◽  
World Health ◽  
Cancer Type ◽  
Immune Microenvironment ◽  
Tumor Immune Microenvironment

Abstract Purpose: The body mass index (BMI) is commonly used as a simple indicator of obesity; patients with early-stage breast cancer who are obese (OB) per BMI measurements have been shown to have high postoperative recurrence and low survival rates. On the other hand, it has been shown that lymphocytes present in the vicinity of malignant growths that are involved in the tumors’ immune responses influence the efficacy chemotherapy. Therefore, we hypothesized that OB patients with breast cancer have a lower density of tumor-infiltrating lymphocytes (TILs), which may influence the therapeutic effect of preoperative chemotherapy (POC). In this study, we measured pretreatment BMI and TILs in patients with breast cancer who underwent POC, examined the correlations between these two factors, and retrospectively analyzed their therapeutic outcomes and prognoses.Methods: The participants in this study were 421 patients with breast cancer who underwent surgical treatment after POC between February 2007 and January 2019. The patient’s height and weight were measured before POC to calculate the BMI (weight [kg] divided by the square of the height [m2]). According to the World Health Organization categorization, patients who weighed under 18.5 kg/m2 were classified as underweight (UW), those ≥18.5 kg/m2 and >25 kg/m2 were considered normal weight (NW), those ≥25 kg/m2 and <30 kg/m2 were overweight (OW), and those ≥30 kg/m2 were OB. The TILs were those lymphocytes that infiltrated the tumor stroma according to the definition of the International TILs Working Group 2014.Results: The median BMI was 21.9 kg/m2 (range, 14.3–38.5 kg/m2); most patients (244; 64.5%) were NW. Among all 378 patients with breast cancer, the TIL density was significantly lower in OB than in NW and OW patients (vs. NW: p=0.001; vs. OW: p=0.003). Furthermore, when examining patients with each breast cancer type individually, the OS of those with TNBC who had low BMIs was significantly poorer than that of their high-BMI counterparts (log rank p=0.031).Conclusions: Our data did not support the hypothesis that obesity affects the tumor immune microenvironment; however, we showed that being UW does affect the tumor immune microenvironment.

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