Postoperative Management for the Obese Patient

2021 ◽  
Author(s):  
Shiliang Alice Cao ◽  
Maurice Frankie Joyce
Keyword(s):  
Obese Patient ◽  
Preoperative Evaluation ◽  
Postoperative Management ◽  
Impaired Wound Healing ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Postoperative Cognitive Decline ◽  
Complete Reversal ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Obesity results in physiologic changes that effect nearly every organ system, including respiratory, cardiovascular, gastrointestinal, endocrine, genitourinary, and neuropsychiatric. These changes are associated with complications in the postoperative period that the anesthesia provider must take into account when planning the anesthetic of the obese patient. Obesity is associated with obstructive sleep apnea, obesity hypoventilation syndrome, and restrictive-type changes in lung volumes that decrease the obese patient’s ability to compensate for the changes that take place with anesthesia. The anesthetic provider should conduct a thorough preoperative evaluation, ensure complete reversal of neuromuscular blockade prior to extubation to prevent obstruction, ensure adequate pain control without compromising respiratory function, and consider use of Continuous positive airway pressure (CPAP) machines for patients on home CPAP. Obesity is also associated with an increased risk of perioperative arrhythmias, thrombotic events, impaired wound healing, decreased kidney function, and postoperative cognitive decline. Anesthetic providers should make every effort to take steps in order to prevent these complications and be knowledgeable about their management should they occur. This review contains 3 figures, 2 tables, 37 references  

Postoperative Management for the Obese Patient

2021 ◽  
Author(s):  
Shiliang Alice Cao ◽  
Maurice Frankie Joyce
Keyword(s):  
Obese Patient ◽  
Preoperative Evaluation ◽  
Postoperative Management ◽  
Impaired Wound Healing ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Postoperative Cognitive Decline ◽  
Complete Reversal ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Obesity results in physiologic changes that effect nearly every organ system, including respiratory, cardiovascular, gastrointestinal, endocrine, genitourinary, and neuropsychiatric. These changes are associated with complications in the postoperative period that the anesthesia provider must take into account when planning the anesthetic of the obese patient. Obesity is associated with obstructive sleep apnea, obesity hypoventilation syndrome, and restrictive-type changes in lung volumes that decrease the obese patient’s ability to compensate for the changes that take place with anesthesia. The anesthetic provider should conduct a thorough preoperative evaluation, ensure complete reversal of neuromuscular blockade prior to extubation to prevent obstruction, ensure adequate pain control without compromising respiratory function, and consider use of Continuous positive airway pressure (CPAP) machines for patients on home CPAP. Obesity is also associated with an increased risk of perioperative arrhythmias, thrombotic events, impaired wound healing, decreased kidney function, and postoperative cognitive decline. Anesthetic providers should make every effort to take steps in order to prevent these complications and be knowledgeable about their management should they occur. This review contains 3 figures, 2 tables, 37 references  

scholarly journals Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea

Thorax ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 459-467 ◽  
Author(s):  
Juan F Masa ◽  
Babak Mokhlesi ◽  
Iván Benítez ◽  
Francisco Javier Gómez de Terreros Caro ◽  
M-Ángeles Sánchez-Quiroga ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Outcome ◽  
Cost Effective ◽  
Sleep Apnoea ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
The Mean ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

BackgroundObesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.ObjectivesWe performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure.MethodsHospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed.ResultsIn total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups.ConclusionCPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA.Trial registration numberNCT01405976

scholarly journals SINDROM PICKWICKIAN-SINDROM HIPOVENTILASI PADA OBESITAS: LAPORAN KASUS DENGAN PENDEKATAN DIAGNOSIS KLINIS

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Ni Luh Putu Dirasandhi Semedi Putri ◽  
Desak Ketut Indrasari Utami ◽  
I Gusti Ngurah Budiarsa ◽  
Sri Yenni Trisnawati
Keyword(s):  
Morbid Obesity ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Blood Gas ◽  
Obesity Hypoventilation Syndrome ◽  
The Past ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

   OBESITY HYPOVENTILATION SYNDROME–THE PICKWICKIAN SYNDROME A CLINICALLY DIAGNOSTIC APPROACH CASE REPORTABSTRACTA 36-year-old man complained about snoring in the past 3 years with a very loud snoring interspersed with choking. This recurs throughout the night, thus, he often experiences excessive drowsiness during the day. He also experienced generalized tonic-clonic seizure in the past six months during sleeping at night or immediately after wake up in the morning. It happened three to four times a week. In the past one month he also experienced a morning headache. He was classified as morbid obesity and had 47.2 cm wide of neck circumference. STOP-BANG score and Snoring Severity Score (SSS) indicated high risk of Obstructive Sleep Apnea. Apnea Hypopnea Index (AHI) was 55.5. The Epworth Sleepiness Scale (ESS) score was 15 indicated to have an excessive sleepiness during the day. Blood gas analysis showed a hypercapnia and chronic hypoventilation condition characterized by the increasing of pCO2 and HCO3- with normal pH. A complete blood count examination showed polycythemia. The patient was diagnosed as Obesity Hypoventilation Syndrome (OHS) based on obesity, OSA, and chronic hypoventilation. With a limited gold standard diagnostic tools, such as polysomnography (PSG), a clinical approach using sleep tools and blood gas analysis to detect early stage OHS still can be made.Keywords: Chronic hypoventilation, morbid obesity, Obesity Hypoventilation Syndrome, obstructive sleep apneaABSTRAKSeorang laki-laki 36 tahun dikeluhkan selalu mendengkur sejak 3 tahun dengan suara dengkuran yang sangat keras diselingi tersedak. Hal ini berulang sepanjang malam hingga pasien sering mengantuk berlebihan di siang hari. Pasien juga mengalami bangkitan umum tonik klonik sejak enam bulan, saat sedang tidur malam hari atau segera setelah terbangun di pagi hari. Sejak 1 bulan, pasien mengeluh sakit kepala saat bangun pagi. Pasien tergolong morbid obesity dan lingkar leher 47,2cm. Skor STOP-BANG dan skor Snoring Severity Score (SSS) menunjukkan risiko tinggi obstructive sleep apneu (OSA), serta Apnea Hypopnea Index (AHI) adalah 55,5. Skor Epworth Sleepiness Scale (ESS) 15 menunjukkan mengantuk berlebihan di siang hari. Pemeriksaan analisis gas darah didapatkan kondisi hiperkapnia dan hipoventilasi kronik berupa peningkatan pCO2 dan HCO3- dengan pH darah cenderung normal. Pemeriksaan darah lengkap menunjukkan polisitemia. Pasien didiagnosis sebagai Sindrom Hipoventilasi pada Obesitas (SHO) karena adanya obesitas, OSA, dan hipoventilasi kronik. Meskipun memiliki keterbatasan alat diagnostik baku emas seperti polisomnografi (PSG), namun pendekatan klinis beserta sleep tools dan analisis gas darah dapat digunakan untuk mendeteksi dini SHO.Kata kunci: Hipoventilasi kronik, morbid obesity, Obesity Hypoventilation Syndrome, obstructive sleep apneu  

scholarly journals Effect of ventilation therapy on mortality rate among obesity hypoventilation syndrome and obstructive sleep apnoea patients

2020 ◽  
Vol 6 (2) ◽  
pp. 00101-2019 ◽  
Author(s):  
Hanna-Riikka Kreivi ◽  
Tuomas Itäluoma ◽  
Adel Bachour
Keyword(s):  
Body Mass Index ◽  
Mortality Rate ◽  
Body Mass ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Control Group ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

IntroductionThe prevalence of obesity is continually increasing worldwide, which increases the incidence of obesity hypoventilation syndrome (OHS) and its consequent mortality.MethodsWe reviewed the therapy mode, comorbidity and mortality of all OHS patients treated at our hospital between 2005 and 2016. The control group consisted of randomly selected patients with obstructive sleep apnoea (OSA) treated during the same period.ResultsWe studied 206 OHS patients and 236 OSA patients. The OHS patients were older (56.3 versus 52.3 years, p<0.001) and heavier (body mass index 46.1 versus 32.2 kg·m−2, p<0.001), and the percentage of women was higher (41.2% versus 24.2%, p<0.001), respectively. The OHS patients had more hypertension (83% versus 61%, p<0.001) and diabetes (62% versus 31%, p<0.001) than the OSA patients, but no higher stroke (4% versus 8%, p=0.058) or ischaemic heart disease (14% versus 15%, p=0.437) incidence. The 5- and 10-year, unadjusted survival rates were lower among the OHS patients than among the OSA patients (83% versus 96% and 74% versus 91%, respectively; p<0.001). Differences in mortality rates were not related to age, sex or body mass index; covariates such as Charlson Comorbidity Index and ventilation therapy predicted survival. The mortality rate decreased significantly (p<0.001) both in OHS and OSA patients even after adjusting for covariates.ConclusionsThe mortality rate in OHS was significantly higher than that in OSA patients even after adjusting for covariates. Ventilation therapy by continuous positive airway pressure or noninvasive ventilation have reduced mortality significantly in all patients.

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