A COMPARATIVE STUDY OF MODIFIED MALLAMPATI CLASSIFICATION WITH NECK CIRCUMFERENCE ALONG WITH UPPER LIP BITE TEST IN MORBIDLY OBESE PATIENTS

INTRODUCTION: Anaesthesia in morbidly obese patients can present many challenges. The overriding concern of most anaesthesiologists is airway management, as obese patients have been thought to be at greater risk of difcult airway and/or difcult intubation, when compared with the general population. The term 'difcult airway' has been dened by the American Society of Anaesthesiologists (ASA) taskforce as the clinical situation in which a conventionally trained anaesthesiologist experiences problems with mask ventilation or tracheal intubation or both. AIMS AND OBJECTIVES- To assess the positive predictive value,sensitivity and specicity of MMPC, NC along with ULBT and compare it with Cormack Lehane grading intraoperatively. MATERIALS AND METHOD- Preoperative airway assessment of 200 patients posted for surgery under general anaesthesia was carried out to evaluate the usefulness of multiple screening tests in predicting the ease or difculty of laryngoscopy in obese patients undergoing laparoscopic bariatric surgery. Modied Mallampati test grade III or IV, Upper Lip Bite test grade III, Neck Circumference >40cm were considered as predictors of difcult laryngoscopy. Laryngoscopy was considered difcult if the view on laryngoscopy was Cormack and Lehane grade III or IV. The results were evaluated on the basis of sensitivity, specicity, positive and negative predictive value and accuracy of these tests. RESULT- Group A (ULBT+MMPC) identied 65% of the patients with difcult intubation (sensitivity of 92.86 % & specicity of 33.3 %), whereas Group B (ULBT+NC) identied 75% of the patients with difcult airway (sensitivity 93.75% & specicity of 25%). Pearson Correlation analysis was applied to know the correlation between the various tests and the Cormack Lehane Classication, both the groups had p value of 0.001 , which was highly signicant. CONCLUSION-When multiple predictors are taken into consideration there was a considerable reduction in false negatives with signicant improvement in accuracy of test and hence prediction of difcult laryngoscopy was made easy. Application of multiple predictors in combination can reduce the frequency of unanticipated difculty and unnecessary interventions related to over prediction of airway difculty.

EP.WE.595Long-term Effects of Psychiatric Medication on Weight Loss after Bariatric Surgery: 5-year Outcomes with 100% Follow Up

Aims The long-term effect of psychiatric medication on weight loss after bariatric surgery is unknown. The aim of this study was to compare the 1 year and 5 year percentage excess weight loss (%EWL) and BMI between those prescribed and not prescribed psychiatric medication who underwent laparoscopic bariatric surgery. Methods Consecutive patients, who received identical perioperative care were selected from a prospectively maintained database. Patients who had gastric bands and revisional procedures were excluded. Patients were defined as “prescribed psychiatric medication” if prescribed antidepressant, antipsychotic or mood stabilizer at baseline and subdivided into those taking a single agent and those on two or more agents. Results Of 119 patients (58 sleeve gastrectomy, 61 gastric bypass), 46 patients were prescribed psychiatric medication (40 one agent, 6 two or more agents). At 1 year, median %EWL did not differ significantly in those taking no agent, 1 agent and 2 or more agents respectively (66.8, 63.3, 57.4, p = 0.433). At 5 years this approached, but did not reach statistical significance (56.6, 54.4, 40.6, p = 0.099). The same pattern was observed for median BMI at 5 years (35.7, 39.2, 40.7, p = 0.086). Conclusion There is no significant difference in excess weight loss or BMI at 1 year post surgery between patients prescribed psychiatric medication and those not prescribed psychiatric medication but there is a difference at 5 years, which shows a trend towards statistical significance. Such patients should receive intensive specialist bariatric psychological support for a prolonged period after surgery.

A Comparative Study between Ultrasound Guided Trans-muscular Quadratus Lumborum Block Versus Ultrasound Guided Transversus Abdominis Plane Block as postoperative analgesia in Laparoscopic Bariatric Surgery

Background A variety of unwanted post-operative consequences, including patient suffering, respiratory distress complications, delirium, myocardial ischemia, prolonged hospital stay and an increased likelihood of chronic pain are due to poorly controlled acute pain after laparoscopic abdominal surgery. Aim of the Work is to compare the analgesic efficacy of ultrasound-guided TQL with TAP block during laparoscopic bariatric surgery and to improve the outcome of the patients undergoing laparoscopic bariatric surgery under general anesthesia who suffer from postoperative pain and also in the early postoperative period regarding pain relief, decreasing postoperative opioid requirements, provision of comfort, early mobilization and improved respiratory functions. Patients and Methods The study was conducted on 40 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 20 patients each: Group TQL (n = 20): received combined general anesthesia with TQL block. Group TAP (n = 20): received combined general anesthesia with TAP block. Results TQL block has more analgesic efficacy than TAP block. The first call for rescue analgesia (Meperidine), total meperidine consumption and pain scores (visual analog score at rest and movement) indicated the superiority of the analgesic technique TQL block. Conclusion TQL with general anesthesia was more effective technique in providing analgesia after laparoscopic bariatric surgery without associated hemodynamic instability in comparison to TAP block with general anesthesia and also the first call for rescue analgesia (Meperidine), total meperidine consumption and pain scores (visual analog score at rest and movement) indicated the superiority of the analgesic technique TQL block.

Comparative Study Between Neostigmine Versus Sugammadex in Obese Patients Undergoing Laparoscopic Surgery

Background Complete and rapid reversal of the effects of neuromuscular blocker drugs is a primary element of safety in anaesthesia. Neuromuscular conduction that is not completely improved leads to post-operative residual curarisation and the development of complications that are related to respiration. Aim of the Work to compare between the effect of neostigmine and sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization and respiratory complications in the obese patients undergoing laparscopic surgery. Patients and Methods We carried out this randomized clinical study on sixty four patients operated upon at General Surgery Department at Armed Forces Hospitals. Patients and Methods: In this study, 64 patients of either sex with average age ranging from 18-65 years, ASA (I,II), submitted for bariatric gastric sleeve operation were included in this study. Patients were randomly classified into 2 equal groups; Group S (sugammadex, n = 32) and group N (neostigmine, n = 32). Results: no significant differences between both groups regarding age, gender, BMI and ASA. But, we showed statistically a high significant difference between both groups regarding TOF0.9 and significant differences between both groups regarding PACU and operative room time. Conclusion This study verified the efficiency of sugammadex over neostigmine for full and timely reversal of neuromuscular blockade induced by a rocuronium, in morbidly obese patients undergoing laparoscopic bariatric surgery.

Arrodált gyomorgyűrűk kezelése – irodalmi áttekintés egy eset kapcsán

Összefoglaló. Bevezetés: 70 éves férfi beteg kóros kövérség (BMI: 50,1) miatt 2005-ben gyomorgyűrű beültetésben részesült. 2020 decemberében hasfali phlegmone hátterében igazolt port infekció miatt más intézetben subcutan incisió, lavage történt. CT-vizsgálattal, majd gasztroszkóppal a gyomorgyűrű arrosióját, intramurális elhelyezkedését igazoltuk. A műtét során laparoszkópos technikával a gyomor corpus nagygörbületén ejtett, kb. 2 cm nagyságú nyíláson keresztül távolítottuk el a gyűrűt. A beteg szövődménymentesen került emisszióra. Megbeszélés: Mintegy 20 évvel ezelőtt a laparoszkópos állítható gyomorgyűrű (LAGB) rendkívül népszerű volt. A LAGB azonban számtalan rövid és hosszú távú szövődménnyel jár, ezért egyre inkább kikerül a bariátriai sebészet tárházából. A gyűrű arrosiója ritka, súlyos szövődmény. Eltávolításának többféle módja lehet. A gyomorgyűrű eltávolítása általában a testsúly jelentős növekedésével jár. A betegeknél konverziós bariátriai műtétet, laparoszkópos gyomor sleeve reszekciót, vagy gyomor bypass műtétet lehet végezni. Summary. Introduction: Extreme obese (BMI: 50.1) 70 year old male patient after LAGB procedure in 2005, with abdominal wall and port infection underwent subcutaneous incision drainage of the area in December 2020. CT and Gastroscopy confirmed gastric penetration and intramural position of the Band. Using laparoscopic approach with incision of 2 cm of the stomach at the gastric greater curvature the band had been removed. Patient had been discharged without any complications. Discussion: LAGB was a very popular bariatric approach at the first decade of laparoscopic bariatric surgery. The increased incidence of short and long term complications reduced worldwide the number of LAGB procedures. Band penetration is a rare but dangerous complication. Laparoscopic removal is recommended. Usually, the intervention is followed by significant weight gain which can be treated with conversion of LAGB to Sleeve Gastrectomy or LGBP procedure.