STUDY DESIGN: Survey. OBJECTIVE: The purpose of this research was to help determine whether sedation is indicated before lumbar and cervical interventional pain management procedures, and additionally, to determine whether benzodiazepams are effective at controlling anxiety for these procedures. SUMMARY OF BACKGROUND DATA: The use of sedation before diagnostic and ...

There is evidence suggesting that the respiratory response to sedation is different in patients with sleep apnoea, which is common in patients with chronic renal failure (CRF). This study examined the respiratory response of sedation with propofol and alfentanil, whose pharmacokinetics are not affected by the renal function, in CRF ...

BACKGROUND: Direct percutaneous endoscopic jejunostomy (DPEJ) is increasingly used as a method for obtaining jejunal enteral access. The most cited reason of unsuccessful placement is poor transillumination, which may be related to obesity. Whether obesity affects failure and complication rates has not been previously described. OBJECTIVE: To compare the success ...

Craniopharyngiomas are embryogenic malformations which lead to eating disorders and morbid obesity due to hypothalamic involvement in about 50% of all patients with pediatric craniopharyngioma. The experience with laparoscopic adjustable gastric banding (LAGB) in obese craniopharyngioma patients is limited. We are reporting on four patients with childhood craniopharyngioma diagnosed at ...

OBJECTIVE: The female preponderance of meningiomas may reflect hormonal influences on meningioma growth. We hypothesized that because obesity affects male steroid hormone synthesis, male patients with meningiomas might exhibit a high obesity rate, which, in turn, might increase their frequency of postoperative complications. METHODS: We retrospectively reviewed male patients who ...

BACKGROUND: Weight loss is recommended among overweight survivors of myocardial infarction (MI). This study describes patterns of weight change among overweight patients with MI and identifies factors associated with weight change. METHODS: A prospective cohort of 1253 overweight or heavier (body mass index [BMI] > or = 25 kg/m2) post-MI ...

OBJECTIVE: We hypothesized that emergency physicians would use more resources to evaluate acute abdominal pain in obese patients as compared with that in nonobese patients. METHODS: We conducted a secondary analysis of a prospective cohort of adults with acute abdominal pain. Collected data included self-reported height and weight, demographics, medical ...

OBJECTIVE: To determine if labor management and outcomes, specifically epidural use, cesarean section and episiotomy rates, are different between patients presenting with formal birth plans and matched control patients without plans. STUDY DESIGN: Patients admitted in labor with birth plans over a 3.5-year period were identified. Patients were excluded if ...

CONTEXT: Awake craniotomy is increasingly performed the world over. We share our experience of performing craniotomy awake with our anesthetic protocol. AIMS: To evaluate and analyze the anesthesia records of the patients who underwent awake craniotomy at our institution. SETTINGS AND DESIGN: University teaching hospital, Retrospective study. MATERIALS AND METHODS: ...

BACKGROUND: Variability in weight loss has been observed from morbidly obese patients receiving bariatric operations. Genetic effects may play a crucial role in this variability. METHODS: 304 morbidly obese patients (BMI > or =39) were recruited, 77 receiving laparoscopic adjustable gastric banding (LAGB) and 227 laparoscopic mini-gastric bypass (LMGB), and ...

BACKGROUND: Changes in metabolic risk factors such as dyslipidemia and hyperinsulinemia as well as levels of sex hormones and leptin were studied in morbidly obese (MO) and super-obese (SO) patients during excess weight loss (EWL), separately in males and females. METHODS: In this prospective clinical intervention study, 431 patients were ...

PURPOSE: Hypotension is a common complication of the sitting position during anesthesia, and is often counteracted by decreasing anesthetic depth, thereby exposing patients to the risk of being inadequately anesthetized. Baroreceptor unloading and the consequent sympathoexcitation, as during head up tilt, decreases pain threshold and arouses the central nervous system ...

BACKGROUND: Prophylactic drainage of wounds is aimed to reduce the wound complications and thereby morbidity. Obese patients are at more risk. The objective of the present study was to determine whether subcutaneous drainage can reduce such complications in elective abdominal surgery (cholecystectomy) in obese patients. DESIGN: Randomized, prospective and comparative ...

BACKGROUND: Propofol infusion syndrome is first manifest by unexplained metabolic acidosis. Its incidence is unknown. METHODS: Charts of all patients undergoing nonsurgical, catheter radiofrequency ablation for atrial flutter or fibrillation from 1999 through 2001 at Mayo Clinic Rochester, who received propofol and had an arterial blood gas drawn during the ...

Antimuscarinic syndrome (AS), a rare but serious adverse event associated with propofol should be included in the differential diagnosis of patients who develop agitation after its administration. We report a case of antimuscarinic syndrome that developed in an emergency department patient immediately after receiving propofol for the reduction of an ...

Obesity has reached epidemic proportions in the United States; hence, it is frequently encountered in patients undergoing (18)F-FDG PET studies. The purpose of the current study was to present a technologist's perspective on the prevalence of obesity and the challenges and solutions in imaging obese patients in our PET facility. ...

CONTEXT AND OBJECTIVE: Inadvertent perioperative hypothermia is common during spinal anesthesia and after midazolam administration. The aim of this study was to evaluate the effects of intraoperative skin-surface warming with and without 45 minutes of preoperative warming in preventing intraoperative and postoperative hypothermia caused by spinal anesthesia in patients with ...

BACKGROUND: The authors investigated body weight, satiation, and gustative pleasure of obese patients 2 years after a bariatric operation: the biliopancreatic diversion with duodenal switch (DS). METHODS: 9 operated patients, 10 unoperated non-obese and 10 unoperated obese persons participated in the "alliesthesia (food distaste) test". This test is a psychometric ...

PURPOSE: To compare the effectiveness for the patient of retrobulbar anaesthesia (RBA) and topical anaesthesia (TA) in cataract surgery by phacoemulsification. METHODS: We performed a prospective, randomized study on 115 patients operated at our clinic using the two anaesthesia techniques. The RBA group comprised 57 patients (20 women, 37 men; ...

Although regional techniques offer superior analgesia during labour, many women receive other methods of pain relief. Furthermore, there is a specific need for analgesia in a small population of labouring women for whom regional techniques are contraindicated, unavailable or impossible to perform. We surveyed current UK practice of labour analgesia ...

BACKGROUND: Adequate patient sedation is mandatory for advanced endoscopic procedures such as ERCP and EUS. AIM: To evaluate the effectiveness and safety of ketamine in difficult to sedate patients undergoing advanced endoscopic procedures. METHODS: This was a prospective, randomized trial of all patients undergoing ERCP or EUS who were not ...

BACKGROUND: Many factors contribute to prolonged length of stay (LOS) for pediatric patients in the postanesthesia care unit (PACU). We designed this prospective study to identify the pre- and postoperative factors that prolong LOS. METHODS: We studied 166 children, aged 1-18 yr, who underwent tonsillectomy and adenoidectomy or tonsillectomy and ...

PURPOSE OF REVIEW: To review the recent advances in providing analgesia and sedation to intensive care unit patients that can improve outcomes, and reduce resource utilization and adverse events. RECENT FINDINGS: Validated tools to assess patient sedation and analgesia are available, and have been shown to improve outcomes when used. ...

BACKGROUND: Vasodilatation and hypotension are thought to be harmful in patients with severe aortic stenosis. Etomidate is preferred to propofol for anaesthesia induction in haemodynamically unstable patients, but may disturb cortisol synthesis. We assessed the haemodynamic effects of etomidate vs. propofol as anaesthesia induction agents, and the effects of these ...

BACKGROUND: Data on safety of intravenous sedation in pediatric GI endoscopy are sparse. OBJECTIVE: To evaluate safety of intravenous sedation for GI endoscopy. DESIGN/SETTING: Single-center prospective series of outpatient GI endoscopies performed from February 2003 to February 2004 at The Children's Hospital of Philadelphia. The recorded information included demographic, medication, ...

OBJECTIVE: To review recent literature on the safety and efficacy of dexmedetomidine. DATA SOURCES: Articles were identified through searches of MEDLINE (1966-January 2007). Key words included dexmedetomidine, medetomidine, alpha(2)-agonist, and sedation. References from selected articles were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies that ...

BACKGROUND: In 2004, the cerebral state monitor, CSM, was launched as a low-cost alternative to the bispectral index, BIS, for monitoring depth of sleep during anaesthesia. We tested whether the two monitors would reflect hypnosis equally during propofol/remifentanil anaesthesia. METHODS: During laparoscopy or breast/surface surgery, 55 non-paralyzed patients were monitored ...

The aim of the study was to assess the frequency of consumption of selected groups of foodstuffs with varying energy value by patients of the "Dom Zdrojowy" sanatorium in Ciechocinek (Poland). The survey included 100 persons, out of which 80% were obese individuals (OB), while the others were patients with ...

BACKGROUND: The aim of this paper was to determine the most common craniofacial changes in patients suffering Obstructive Sleep Apnea Syndrome (OSAS) with regards to the degree of obesity. Accordingly, cephalometric data reported in the literature was searched and analyzed. METHODS: After a careful analysis of the literature from 1990 ...

BACKGROUND: Obesity is considered a highly prevalent risk factor for venous thromboembolism (VTE) in hospitalized patients. However, recommendations for VTE prophylaxis in obese patients are not clear. METHODS: To evaluate obesity as a risk factor for VTE in medical and bariatric patients and the efficacy of VTE prophylaxis, we performed ...

Impaired surgical site healing occurs in 20% to 50% of sirolimus (SRL)-treated renal transplant (RT) recipients, with most patients having received concomitant corticosteroids. We determined the incidence of surgical site complications among RT recipients receiving SRL with mycophenolate mofetil (MMF), with most patients on a steroid-avoidance protocol. SRL/MMF patients with ...

The purpose of this study was to assess prospectively the potential of low-dose intranasal midazolam compared to oral midazolam in claustrophobic patients undergoing routine body magnetic resonance imaging (MRI). Seventy-two adult claustrophobic patients referred for body MRI were randomly assigned to one of two treatment groups (TG1 and TG2). The ...

OBJECTIVE: The aim of this study was to evaluate the effectiveness of analgesia delivery, in the emergency department setting, to patients presenting with acute pain, with regard to guidelines from the British Association of Accident and Emergency Medicine (BAEM). METHODS: A retrospective analysis of patient records. We measured the time ...

PURPOSE: To report a case of peripartum dilated cardiomyopathy presenting for emergency caesarean section, this was successfully managed with Epidural Anaesthesia. CLINICAL FEATURES: A parturient suffering from idiopathic peripartum cardiomyopathy (E.F. 18%) was brought for an emergency caesarean section. Epidural anaesthesia was performed and 2% Lignocaine with adrenaline total 13 ...

OBJECTIVES: To evaluate the effect of body mass index (BMI) on in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI) at a tertiary care hospital center in Ontario, Canada. BACKGROUND: Obesity is present in a large population of patients undergoing revascularization with PCI. METHODS: Retrospective analysis of 4,631 patients aged ...

BACKGROUND: The outcome of laparoscopic colectomy with completely intracorporeal anastomosis (LCIA) in obese and nonobese patients is assessed. METHODS: Forty-five consecutive patients who underwent LCIA for benign or malignant disease of the right and proximal left colon were reviewed prospectively. Obesity was defined as a body mass index of >30 ...

Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (Fio2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean patients but ...

AIM: In a recent epidemiological study on chronic venous disease (CVD) in French male patients, a correlation was found between obesity and disease severity. The objective of this study was to further analyze the relationship between age and/or obesity, and CVD severity as assessed by the CEAP C-class. METHODS: Each ...

Our aim was to compare patients' satisfaction and cooperation, and clinical efficacy, of midazolam alone, and midazolam and remifentanil for patient-controlled sedation during removal of third molars. Forty patients, American Society of Anesthesiologists grades I and II, admitted for extraction of impacted mandibular third molars were included in this randomised, ...

STUDY OBJECTIVE: To evaluate the potential differences in the type of anesthesia provided to patients of different race, gender, and source of payment undergoing inguinal hernia repair (IHR). DESIGN: Retrospective cohort study. SETTING: Ambulatory surgical centers/National Survey of Ambulatory Surgery. PATIENTS: 5810 patients older than 14 years who underwent IHR ...

PURPOSE: The reported prevalence of mild and severe obesity among US children is 30% and 15%, respectively. Childhood obesity likely relates to alterations in diet that also may cause constipation. We investigated the relationship between obesity and various forms of elimination dysfunction. MATERIALS AND METHODS: The data of 251 patients ...

Objective: The purpose of this study was to investigate the optimal dosage of intravenous midazolam for sedation in elderly patients and compare the amount of depression of respiratory function and skeletal muscle activity after obtaining similar sedation levels in younger patients. Patients and Methods: Fifteen elderly patients older than 65 ...

OBJECTIVE: The purpose of the study was to evaluate the stability of the maternal pelvis over the course of the third trimester and the puerperium. STUDY DESIGN: Pregnant patients were recruited to undergo comparative magnetic resonance-based pelvimetry and fetal ultrasonography at 37 to 38 weeks of gestation. Most of the ...

Awareness under general anesthesia is an infrequent phenomenon during which patients become cognizant of some or all events during surgery or any procedure conducted under anesthesia. Awareness experiences can frighten patients and impact their memories in ways that can leave emotional and psychological problems that, over time, may develop into ...

BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally. PATIENTS AND ...

Craniopharyngioma is a rare dysontogenetic benign tumor. Patients frequently suffer from endocrine deficiencies, sleep disturbances and obesity due to pituitary and hypothalamic lesions. A self-assessment daytime sleepiness questionnaire (German version of the Epworth Sleepiness Scale [ESS]) was used to evaluate 79 patients with childhood craniopharyngioma. Because hypothalamic lesions may explain ...

Regional anesthesia in the obese patient can be challenging and possibly carries a greater failure rate as compared with that in the non-obese patient. We retrospectively reviewed our prospectively gathered peripheral block data to determine the influence of body weight on success rate of the supraclavicular block. Obesity was defined ...

Anterior shoulder dislocation is the most common dislocation in the body. Various methods of anesthesia are available for reduction. The objective of this study was to compare the application of intra-articular anesthesia with intravenous anesthesia for reduction of acute anterior shoulder dislocation. This study was conducted at Kathmandu Medical College ...

BACKGROUND: Anesthesia adversely affects respiratory function and hemodynamics in obese patients. Although many studies have been performed in morbidly obese patients, data are limited concerning overweight patients [BMI 25-29.9 kg m(-2)]. The aim of this study was to evaluate the effects of prolonged pneumoperitoneum in Trendelenburg position on hemodynamics and ...

PURPOSE: An audit study investigated the pilot use of regional nerve block analgesia (as an alternative to sedative/opiate, general or central neuraxial anesthesia) performed by radiologists with the assistance of imaging techniques during complex prolonged angiography. METHODS: Radiologists were trained by anesthetic consultants to administer and use lower limb peripheral ...