scholarly journals Oxygenation Impairment during Anesthesia

2019 ◽  
Vol 131 (1) ◽  
pp. 46-57 ◽  
Author(s):  
Göran Hedenstierna ◽  
Leif Tokics ◽  
Gaetano Scaramuzzo ◽  
Hans U. Rothen ◽  
Lennart Edmark ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Arterial Oxygen Tension ◽  
Quadratic Function ◽  
Arterial Oxygen ◽  
Primary Analysis ◽  
Aged Patients ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Oxygenation Impairment

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Anesthesia is increasingly common in elderly and overweight patients and prompted the current study to explore mechanisms of age- and weight-dependent worsening of arterial oxygen tension (Pao2). Methods This is a primary analysis of pooled data in patients with (1) American Society of Anesthesiologists (ASA) classification of 1; (2) normal forced vital capacity; (3) preoxygenation with an inspired oxygen fraction (Fio2) more than 0.8 and ventilated with Fio2 0.3 to 0.4; (4) measurements done during anesthesia before surgery. Eighty patients (21 women and 59 men, aged 19 to 69 yr, body mass index up to 30 kg/m2) were studied with multiple inert gas elimination technique to assess shunt and perfusion of poorly ventilated regions (low ventilation/perfusion ratio []) and computed tomography to assess atelectasis. Results Pao2/Fio2 was lower during anesthesia than awake (368; 291 to 470 [median; quartiles] vs. 441; 397 to 462 mm Hg; P = 0.003) and fell with increasing age and body mass index. Log shunt was best related to a quadratic function of age with largest shunt at 45 yr (r2 =0.17, P = 0.001). Log shunt was linearly related to body mass index (r2 = 0.15, P < 0.001). A multiple regression analysis including age, age2, and body mass index strengthened the association further (r2 = 0.27). Shunt was highly associated to atelectasis (r2 = 0.58, P < 0.001). Log low showed a linear relation to age (r2 = 0.14, P = 0.001). Conclusions Pao2/Fio2 ratio was impaired during anesthesia, and the impairment increased with age and body mass index. Shunt was related to atelectasis and was a more important cause of oxygenation impairment in middle-aged patients, whereas low, likely caused by airway closure, was more important in elderly patients. Shunt but not low increased with increasing body mass index. Thus, increasing age and body mass index impaired gas exchange by different mechanisms during anesthesia.

Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with either TURis or transurethral resection of the prostate method

2018 ◽  
Vol 86 (2) ◽  
pp. 69-73
Author(s):  
Eleftheria Chalari ◽  
George Intas ◽  
Sofia Zyga ◽  
Georgios Fildissis ◽  
Maria Tolia ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Transurethral Resection ◽  
Core Body Temperature ◽  
Lower Body ◽  
Lower Body Mass Index ◽  
Duration Of Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Core Body

Purpose: The purpose of the study was to investigate the incidence of perioperative hypothermia in urology patients undergoing transurethral resection with either TURis or transurethral resection of the prostate method and to recognize the risk factors that were responsible for the occurrence of hypothermia intraoperatively in these patients. Methods: It was a randomized prospective study. A total of 168 patients, according to American Society of Anesthesiologists physical status I–III, were scheduled for transurethral resection either with TURis or transurethral resection of the prostate method. We measured the core body temperature before (preoperative), during (perioperative) and after (postoperative) the surgery. Age, body mass index, American Society of Anesthesiologists score, duration of surgery, preoperative prostatic volume, and vital signs were also recorded. Results: The prevalence of inadvertent hypothermia was 64.1% for the TURis group and 60% for the transurethral resection of the prostate group. Hypothermic patients in TURis group were significantly older (87.7 ± 1.7 vs 68 ± 6.7 years, p < 0.05) and had lower body mass index (26.9 ± 3.6 vs 29.2 ± 2.7, p < 0.05), while hypothermic patients in the transurethral resection of the prostate group were significantly older (86 ± 1.1 vs 70 ± 7.4 years, p < 0.05) and had notably higher duration of surgery (140.6 ± 28.9 vs 120.3 ± 14.3 min, p < 0.05) than normothermic patients. Conclusion: Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with both TURis and transurethral resection of the prostate method is of high incidence. We recommend monitoring of the temperature of core body of all these patients, especially those with advanced age and lower body mass index.

scholarly journals Somatostatin administration following pancreatoduodenectomy: a case-matched comparison according to surgical technique, body mass index, American Society of Anesthesiologists’ score and Fistula Risk Score

Surgery Today ◽  
2020 ◽  
Author(s):  
Niccolò Furbetta ◽  
Desirée Gianardi ◽  
Simone Guadagni ◽  
Gregorio Di Franco ◽  
Matteo Palmeri ◽  
...  
Keyword(s):  
Body Mass Index ◽  
High Risk ◽  
Body Mass ◽  
Risk Score ◽  
Digestive Bleeding ◽  
High Risk Patients ◽  
Risk Patients ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Fistula Risk Score

Abstract Purpose This study evaluated the controversial role of somatostatin after pancreatoduodenectomy (PD), stratifying patients for the main risk factors using the most recent postoperative pancreatic fistula (POPF) classification and including only patients who had undergone PD with the same technique of pancreatojejunostomy. Methods Between November 2010 and February 2020, 218 PD procedures were carried out via personal modified pancreatojejunostomy (mPJ-PD). Somatostatin was routinely administered between 2010 and 2016, while from 2017, 97 mPJ-PD procedures without somatostatin (WS) were performed. The WS group was retrospectively compared with a control (C) group obtained with one-to-one case–control matching according to the body mass index, American Society of Anesthesiologists’ score, and Fistula Risk Score (FRS). Results A total of 144 patients (72 WS group versus 72 C group) were compared. In the WS group. 6 patients (8.3%) developed clinically relevant POPF, compared with 8 patients (11.1%) in the C group (p = 0.656). In addition, on analyzing the subgroup of high-risk patients according to the FRS, we did not note any significant differences in POPF occurrence. Furthermore, no marked differences in the morbidity or mortality were found. Digestive bleeding and diabetes onset rates were higher in the WS group than in the control group, but not significantly so. Conclusions The results of the present study confirm no benefit with the routine administration of somatostatin after PD to prevent POPF, even in high-risk patients. However, a possible role in the prevention of postoperative digestive bleeding and diabetes was observed.

Can Transfusions be Eliminated in Major Abdominal Surgery? Analysis of a Vive-Year Experience of Blood Conservation in Patients Undergoing Pancreaticoduodenectomy

2015 ◽  
Vol 81 (10) ◽  
pp. 983-987 ◽  
Author(s):  
Matthew B. Singer ◽  
Marwan Sheckley ◽  
Vijay G. Menon ◽  
Vinay Sundaram ◽  
Vladimir Donchev ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Iron Supplementation ◽  
Surgical Patient ◽  
Entire Group ◽  
Transfusion Rate ◽  
Improved Outcomes ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Perioperative Blood Transfusion

Pancreaticoduodenectomy (PD) has historically required perioperative blood transfusion in 40 to 60 per cent of cases. Growing data suggest that transfusions may be deleterious in the surgical patient. We recently initiated a minimal transfusion approach to PD consisting of limited postoperative blood draws, early iron supplementation, changes in surgical technique, and elimination of hemoglobin transfusion triggers. Predictors of perioperative transfusion were analyzed in 130 consecutive patients undergoing PD by a single surgeon between 2008 and 2013, divided into two eras with 65 patients each. Patients in each era were similar with respect to age, comorbidities, American Society of Anesthesiologists class, body mass index, and diagnosis. The transfusion rate for the entire group was 22 per cent. Nonsignificant predictors of perioperative transfusion include American Society of Anesthesiologists class ≥3 ( P = 0.41), vascular resections ( P = 0.56), body mass index ≥30 ( P = 0.72), and intraoperative blood loss ( P = 0.89). Significant predictors of transfusion include PD performed in Era 1 as well as preoperative hemoglobin levels <10 g/dL. In Era 1, 38 per cent of patients required transfusion compared with 6 per cent in Era 2 ( P < 0.01). Shorter length of stay and a trend toward decreased pancreatic fistulae were seen in Era 2. Transfusions can be almost completely eliminated in PD and this may contribute to improved outcomes.

scholarly journals Risk factors for poor health-related quality of life in patients with colon cancer include stoma and smoking habits

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Catarina Tiselius ◽  
Andreas Rosenblad ◽  
Eva Strand ◽  
Kenneth Smedh
Keyword(s):  
Quality Of Life ◽  
Body Mass Index ◽  
Colon Cancer ◽  
Body Mass ◽  
Physical Status ◽  
Related Quality ◽  
Health Related ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Previous studies have shown that health-related quality of life (HRQoL) is associated with the prognosis of cancer patients. The aim of this study was to investigate risk factors for poor HRQoL in patients with colon cancer. Methods This was a prospective population-based study of patients with colon cancer included between 2012 and 2016. HRQoL was measured using the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. Multiple linear regression analysis adjusted for age, sex, body mass index, smoking habits, American Society of Anesthesiologists physical status classification, emergency/elective surgery, resection with/without a stoma and tumour stage was used. Results A total of 67% (376/561) of all incident patients with colon cancer (196 [52.1%] females) was included. Mean (range) age was 73 (30–96) years. Patients with worse health (American Society of Anesthesiologists physical status 3 and 4), those with higher body mass index, smokers and those planned to undergo surgical treatment with a stoma were at a higher risk for poor HRQoL than the other included patients at baseline and 6-month follow-up. Conclusions Patient characteristics such as smoking, high body mass index and worse physical health as well as treatment with a stoma were associated with lower HRQoL. Health care for such patients should focus on social and lifestyle behavioural support and stoma closure, when possible. Trial registration: ClinicalTrials.gov (NCT 03910894).

scholarly journals Association between low body mass index and increased 28-day mortality of severe sepsis in Japanese cohorts

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takehiko Oami ◽  
◽  
Satoshi Karasawa ◽  
Tadanaga Shimada ◽  
Taka-aki Nakada ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Body Mass ◽  
Validation Cohort ◽  
Univariate Analysis ◽  
University Hospital ◽  
Primary Analysis ◽  
Derivation Cohort ◽  
Asian Populations

AbstractCurrent research regarding the association between body mass index (BMI) and altered clinical outcomes of sepsis in Asian populations is insufficient. We investigated the association between BMI and clinical outcomes using two Japanese cohorts of severe sepsis (derivation cohort, Chiba University Hospital, n = 614; validation cohort, multicenter cohort, n = 1561). Participants were categorized into the underweight (BMI < 18.5) and non-underweight (BMI ≥ 18.5) groups. The primary outcome was 28-day mortality. Univariate analysis of the derivation cohort indicated increased 28-day mortality trend in the underweight group compared to the non-underweight group (underweight 24.4% [20/82 cases] vs. non-underweight 16.0% [85/532 cases]; p = 0.060). In the primary analysis, multivariate analysis adjusted for baseline imbalance revealed that patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group (p = 0.031, adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.06–3.46). In a repeated analysis using a multicenter validation cohort (underweight n = 343, non-underweight n = 1218), patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group (p = 0.045, OR 1.40, 95% CI 1.00–1.97). In conclusion, patients with a BMI < 18.5 had a significantly increased 28-day mortality compared to those with a BMI ≥ 18.5 in Japanese cohorts with severe sepsis.

scholarly journals WAYS TO IMPROVE NATURAL FERTILITY

2021 ◽  
Vol 74 (1) ◽  
pp. 144-149
Author(s):  
Tetiana V. Fartushok ◽  
Halyna B. Semenyna ◽  
Oksana M. Yurchyshyn ◽  
Olha S. Komissarova
Keyword(s):  
Body Mass Index ◽  
Retrospective Analysis ◽  
Body Mass ◽  
Reproductive Medicine ◽  
The Body ◽  
Caffeine Intake ◽  
Natural Fertility ◽  
Reproductive Endocrinology ◽  
American Society

The aim: Based on the study of the results of retrospective analysis, optimize ways to improve natural fertility. Materials and methods: Data from the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility were used to study this problem. Conclusions: With a body mass index > 35, the time reguired for conception increases by 2 times. At the same time, when the body mass index <19, the time reguired for conception increases by 4 times. Increased levels of mercury in seafood are associated with infertility. Smoking accelerates the rate of exhaustion of the ovarian follicular apparatus. When trying to become pregnant, it is advisable to avoid drinking more than 2 servings per day. Caffeine intake over 5 cups/day in women correlates with reduced fertility.

Association of Adult Socioeconomic Status with Body Mass Index: A Within- and Between-Twin Study

2021 ◽  
pp. 1-7
Author(s):  
Samuel J. C. Crofts ◽  
Janine Lam ◽  
Katrina J. Scurrah ◽  
Gillian S. Dite
Keyword(s):  
Body Mass Index ◽  
Socioeconomic Status ◽  
Body Mass ◽  
Twin Studies ◽  
Confounding Factors ◽  
Primary Analysis ◽  
Cross Sectional ◽  
Socioeconomic Index ◽  
Unit Increase ◽  
Lifestyle Questionnaire

Abstract Adult socioeconomic status (SES) has been consistently associated with body mass index (BMI), but it is unclear whether it is linked to BMI independently of childhood SES or other potentially confounding factors. Twin studies can address this issue by implicitly controlling for childhood SES and unmeasured confounders. This co-twin control study used cross-sectional data from Twins Research Australia’s Health and Lifestyle Questionnaire (N = 1918 twin pairs). We investigated whether adult SES, as measured by both the Index of Relative Socioeconomic Disadvantage (IRSD) and the Australian Socioeconomic Index 2006 (AUSEI06), was associated with BMI after controlling for factors shared by twins within a pair. The primary analysis was a linear mixed-effects model that estimated effects both within and between pairs. Between pairs, a 10-unit increase in AUSEI06 was associated with a 0.29 kg/m2 decrease in BMI (95% CI [−.42, −.17], p < .001), and a 1-decile increase in IRSD was associated with a 0.26 kg/m2 decrease in BMI (95% CI [−.35, −.17], p < .001). No association was observed within pairs. In conclusion, higher adult SES was associated with lower BMI between pairs, but no association was observed within pairs. Thus, the link between adult SES and BMI may be due to confounding factors common to twins within a pair.

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