PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 3319903

Pulmonary function in morbid obesity.

H J Sugerman
View original source ↗Export metadata ↓

Abstract

Morbid obesity is not infrequently associated with severe respiratory impairment. In our experience approximately 10 per cent of morbidly obese patients who underwent gastric surgery had severe respiratory impairment. Respiratory insufficiency of obesity can be divided into two primary breathing disorders: the obstructive sleep apnea syndrome (SAS) and the obesity hypoventilation syndrome (OHS). In its most severe form, when both SAS and OHS are present, it is called the Pickwickian syndrome. In our series 59 morbidly obese patients with respiratory insufficiency secondary to obesity underwent gastric surgery for weight reduction. Fourteen had OHS, 19 had SAS and 26 had both. Of these, two patients died of postoperative complications and one died at five weeks with an inconclusive autopsy, totalling an operative mortality rate of 3.4 per cent and a total mortality of 5.1 per cent. In our overall experience morbidly obese patients lost 67 per cent of excess weight after gastric procedures. In conclusion, surgically induced weight loss will markedly improve or correct respiratory insufficiency secondary to obesity. It will improve arterial oxygenation, minimize CO2 retention, expand lung volumes, correct polycythemia, and reduce apnea frequency. The magnitude of changes in these variables is clinically significant. Therefore, respiratory insufficiency of obesity should be considered a major indication for an aggressive approach to weight reduction. The jejunoileal bypass and unbanded gastroplasty operations have an unacceptable incidence of complications or failure, respectively. There is a high degree of recidivism following dietary programs. Sweets eaters will not do well with a gastroplasty procedure. Gastric bypass for individuals addicted to sweets or the vertical banded gastroplasty for "gorgers" are currently our procedures of choice and are associated with the average loss of two thirds of excess weight and correction of breathing problems associated with morbid obesity.

Explore related subjects

AnesthesiaHumansHypoventilationLungObesity Hypoventilation SyndromeObesity, MorbidRespiratory Function TestsRisk FactorsSleep Apnea SyndromesStomachJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

H J Sugerman. 1987. Pulmonary function in morbid obesity.. https://pubmed.ncbi.nlm.nih.gov/3319903/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Increase in exhaled nitric oxide and protective role of the nitric oxide system in experimental pulmonary embolism.

BACKGROUND AND PURPOSE: Pulmonary embolism (PE) represents a real diagnostic challenge. PE is associated with pulmonary hypertension due to pulmonary vascular obstruction and vasoconstriction. We recently reported that pulmonary gas embolism transiently increases exhaled nitric oxide (FENO), but it is not known whether solid emboli may alter FENO, and whether an intact endogenous NO synthesis has a beneficial effect in experimental solid pulmonary embolism. EXPERIMENTAL APPROACH: We used anaesthetised and ventilated rabbits in these experiments. To mimic PE, a single intravenous infusion of homogenized autologous skeletal muscle tissue (MPE) was given to rabbits with intact NO production (MPE of 60, 15, or 7.5 mg kg(-1); group 1) and to another group (group 2) with inhibited NO synthesis (L-NAME 30 mg kg(-1); MPE of 7.5, 15 or 30 mg kg(-1)). KEY RESULTS: In group 1, after MPE, FENO increased rapidly and dose-dependently and FENO was still significantly elevated after 60 min with the two highest emboli doses. All these animals survived more than 60 min after embolization. In group 2, MPE of 7.5, 15 and 30 mg kg(-1), in combination with NO synthesis inhibition, resulted in 67%, 50% and 25% survival at 60 min respectively, representing a statistically significant decrease in survival. Cardiovascular and blood-gas changes after MPE were intensified by pre-treatment with NO synthesis inhibitor. CONCLUSIONS AND IMPLICATIONS: We conclude that solid PE causes a sustained, dose-dependent increase in FENO, giving FENO a diagnostic potential in PE. Furthermore, intact NO production appears critical for tolerance to acute PE.

Anesthesia↗
PubMed2007

Evaluation of a laryngoscope and a rigid endoscope for the examination of the oral cavity of small mammals.

The oral cavities of 65 rabbits, 35 chinchillas, 38 guinea pigs, 19 degus and 13 prairie dogs suffering from a lack of appetite, hypersalivation, moist dermatitis, swelling of the lower jaw or mild exophthalmos were examined with a paediatric laryngoscope and rigid endoscope. The laryngoscope was safe and satisfactory for a preliminary examination, but changes in the less accessible caudal parts of the cavity could not be identified precisely. A rigid endoscope with 30 degrees optics made it possible to examine all parts of the oral cavity and oropharynx, and make detailed observations of surface lesions on the premolar and molar teeth and the mucosal surface of the gingiva, tongue and hard palate; endoscopy with 70 degrees optics provided an excellent view of the occlusal tooth surfaces, tooth crowns, and buccal mucosa. The collection of biopsy samples, the removal of foreign objects and the correction of malocclusions were greatly simplified by the use of the endoscope owing to the clear visualisation of the procedures, and the risk of injury was minimised. The examinations with a laryngoscope were made effectively on animals that were manually restrained, but a thorough examination with a rigid endoscope required the animals to be anaesthetised.

Anesthesia↗
PubMed2007

Perioperative management of familial dysautonomia: a systematic review.

BACKGROUND AND OBJECTIVE: Familial dysautonomia (FD), a rare genetic disorder, is characterized by autonomic instability, pulmonary infections, oesophageal dysmotility, spinal abnormalities and episodic "dysautonomic crisis" characterized by rash, vomiting, sweating and hypertension. Frequent anaesthetic complications have been reported. METHODS: We performed a comprehensive literature search of perioperative management of FD using an OVID-based search strategy. Identified reports were reviewed to identify perioperative complications as well as anaesthetic techniques and perioperative management strategies developed to minimize or prevent these complications. RESULTS: Eighteen case reports or series of perioperative management of FD were identified in the literature for a total of 179 patients undergoing 290 anaesthetics. Intraoperative cardiovascular lability, including cardiac arrests and postoperative pulmonary complications were commonly reported. Preoperative hydration, minimizing the use of volatile anaesthetic agents, postoperative ventilation, use of regional anaesthesia and minimally invasive surgical techniques reduced the incidence of these complications. CONCLUSIONS: While patients with FD are reported to have a relatively high rate of various perioperative complications, a full understanding of its pathophysiology can be used to develop a perioperative management strategy to anticipate and prevent many of these complications.

Anesthesia↗