Anesthetic management for robotic hysterectomy in obese women

Abstract. Objectives: Obesity plays an important role in the development of chronic diseases including cardiovascular disease and diabetes. A low resting metabolic rate (RMR) for a given body size and composition is a risk factor for obesity, however, there is limited evidence available regarding the association of nutrient patterns and RMR. The aim of this study was to determine the association of nutrient patterns and RMR in overweight and obese women. Study design: This cross-sectional study was conducted on 360 women who were overweight or obese. Method: Dietary intake was assessed using a semi-quantitative standard food frequency questionnaire (FFQ). Nutrient patterns were also extracted by principal components analysis (PCA). All participants were evaluated for their body composition, RMR, and blood parameters. Result: Three nutrient patterns explaining 64% of the variance in dietary nutrients consumption were identified as B-complex-mineral, antioxidant, and unsaturated fatty acid and vitamin E (USFA-vit E) respectively. Participants were categorized into two groups based on the nutrient patterns. High scores of USFA-vit E pattern was significantly associated with the increase of RMR (β = 0.13, 95% CI = 0.79 to 68.16, p = 0.04). No significant associations were found among B-complex-mineral pattern (β = −0.00, 95% CI = −49.67 to 46.03, p = 0.94) and antioxidant pattern (β = 0.03, 95% CI −41.42 to 22.59, p = 0.56) with RMR. Conclusion: Our results suggested that the “USFA-vit E” pattern (such as PUFA, oleic, linoleic, vit.E, α-tocopherol and EPA) was associated with increased RMR.

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Das rupturierte infrarenale Aortenaneurysma – eine kritische Analyse

VASA ◽

10.1024/0301-1526.28.1.30 ◽

1999 ◽

Vol 28 (1) ◽

pp. 30-33 ◽

Cited By ~ 9

Author(s):

Bürger ◽

Meyer ◽

Tautenhahn ◽

Halloul

Keyword(s):

Aortic Aneurysm ◽

Aortic Rupture ◽

Anesthetic Management ◽

Objective Evaluation ◽

Left Ventricular ◽

Apache Ii ◽

Apache Ii Score ◽

Infrarenal Aortic Aneurysm ◽

Emergency Situations ◽

Probability Of Death

Background: Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. Patients and methods: Fifty-two consecutive patients with ruptured infrarenal aortic aneurysm (mean age, 70.3 years; range, 56–89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final reports, and follow-up data were analyzed retrospectively. APACHE II scores at admission and fifth postoperative day were assessed. Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Thirty-eight patients (71%) had signs of shock at time of admission. Ultrasound was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). Intraoperatively, acute left ventricular failure occurred in four patients, and cardiac arrest in two others. The postoperative course was complicated significantly in 34 patients. The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of death of more than 40% in five patients and lower than 30% in 17 others. No patient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient’s prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups can be compared.

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Successful Endovascular Repair of a Leaking Abdominal Aortic Aneurysm under Local Anesthesia

Swiss Surgery ◽

10.1024/1023-9332.7.2.86 ◽

2001 ◽

Vol 7 (2) ◽

pp. 86-89 ◽

Cited By ~ 17

Author(s):

Lachat ◽

Pfammatter ◽

Bernard ◽

Jaggy ◽

Vogt ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Ct Scan ◽

Local Anesthesia ◽

Endovascular Repair ◽

Anesthetic Management ◽

High Risk Patient ◽

Invasive Technique ◽

Chronic Obstructive ◽

Abdominal Aortic

Local anesthesia is a safe and less invasive anesthetic management for the endovascular approach to elective aortic aneurysm. We have successfully extended the indication of local anesthesia to a high-risk patient with leaking aneurysm and stable hemodynamics. Patient and methods: A 86 year old patient with renal insufficiency due to longstanding hypertension, coronary artery and chronic obstructive lung disease was transferred to our hospital with a leaking abdominal aortic aneurysm. Stable hemodynamics allowed to perform a fast CT scan, that confirmed the feasibility of endovascular repair. A bifurcated endograft (24mm x 12mm x 153mm) was implanted under local anesthesia. Results: The procedure was completed within 85 minutes without problems. The complete sealing of the aneurysm was confirmed by CT scan on the third postoperative day. Twenty months later, the patient is doing well and radiological control confirmed complete exclusion of the aneurysm. Discussion: The endoluminal treatment is a minimally invasive technique. It's feasibility can be rapidly assessed by CT scan. The transfemoral implantation can be performed under local anesthesia provided that hemodynamics are stable. This anesthetic management seems to be particularly advantageous for leaking abdominal aortic aneurysm since it doesn't change the hemodynamic situation in contrast to general anesthesia. Hemodynamic instability, abdominal distension or tenderness may indicate intraperitoneal rupture and conversion to open graft repair should be performed without delay.

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Weight loss "maintainers" vs. "regainers": Posttreatment physical activity facilitates weight maintenance in obese women

PsycEXTRA Dataset ◽

10.1037/e546872013-114 ◽

2013 ◽

Author(s):

Renee T. Degener ◽

Melissa H. Laitner ◽

Danielle M. Lespinasse ◽

Kristen E. Medina ◽

Stacey N. Maurer ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Weight Maintenance ◽

Obese Women

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The effects of diet and exercise programs for overweight or obese women during pregnancy

PsycEXTRA Dataset ◽

10.1037/e570112013-014 ◽

2013 ◽

Author(s):

Catherine L. Kempster ◽

Rasika S. Jayasekara

Keyword(s):

Obese Women ◽

Exercise Programs ◽

Diet And Exercise

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Metformin Decreases the High Plasminogen Activator Inhibition Capacity, Plasma Insulin and Triglyceride Levels in Non-Diabetic Obese Subjects

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651126 ◽

1987 ◽

Vol 57 (03) ◽

pp. 326-328 ◽

Cited By ~ 118

Author(s):

Ph Vague ◽

I Juhan-Vague ◽

M C Alessi ◽

C Badier ◽

J Valadier

Keyword(s):

Plasminogen Activator ◽

Fibrinolytic Activity ◽

Plasma Insulin ◽

Normal Glucose Tolerance ◽

Double Blind Study ◽

Obese Women ◽

Double Blind ◽

Normal Glucose ◽

Plasma Insulin Levels ◽

Obese Subjects

SummaryWe have previously observed a positive correlation between Plasminogen Activator Inhibition capacity (PA Inhibition), Body Mass Index (BMI) and plasma insulin levels in a population of non diabetic subjects. The anti diabetic biguanide Metformin which decreases insulin resistance has been reported to increase the blood fibrinolytic activity. Therefore we have studied the effect of Metformin on PA Inhibition levels in obese subjects with normal glucose tolerance. Eighteen obese women (O) (BMI: 31.4 ± 1.13, m ± S.E.M.) were compared to age matched controls (C) (BMI: 20.2 ± 0.8) and randomized to a 15 days treatment by Metformin (M) (1.7 g/day) or placebo (P) in a double blind study while on a weight maintaining diet. O compared to C had higher levels (m ± S.E.M.) of PA Inhibition (9 ± 1.8 IU/ml, versus 2.88 ± 0.29 p <0.01), lower euglobulin fibrinolytic activity (EFA) (4.95 ±1.17 mm versus 9 ± 0.29 p <0.05), higher plasma insulin (24.1 ±2.1. uU/ml), versus 12 ± 1 p <0.01) and triglyceride (1.32 ± 0.16 mmol/1, versus 0.8 ± 0.08 p <0.05). After 15 days of treatment, in group M a significant decrease in PA Inhibition (5.51 ± 1.4, versus 9.48 ±2.1 p <0.05) in plasma insulin (18.5 ±0.1, versus 24.5 ± 3.5, p <0.05) and plasma triglyceride (1.08 ± 0.1, versus 1.47 ± 0.3 p <0.05) and an increase in EFA (6.50 ± 0.28, versus 5.25 ± 0.35 p <0.05) were observed. No significant variation was observed in group P.

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