Background: Opioid anesthetic agents can modulate the impaired immune response in obese patients through mechanisms that involve the expression and release of cytokines. For this reason, anesthetic care for obese patients remains controversial. Therefore, the aim of the study was to compare the effect of opioid-containing anesthesia (OCA) vs opioid-free anesthesia (OFA) using the Cortínez-Sepúlveda model on IL-6, IL-1β and TNF-α serum levels before and after surgery in obese patients undergoing bypass surgery. Methods:This randomized cross-sectional study conducted among 40 unrelated obese adults was performed in the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca". Before undergoing laparoscopic Roux-en-Y gastric bypass, patients were randomly assigned to two anesthesia groups: OCA (n = 20) or OFA (n = 20). Fentanyl was the opioid used in the OCA group. The Cortínez-Sepúlveda pharmacokinetic model was used to characterize the disposition of intravenous propofol for the target-controlled infusion technique in obese patients. Body mass was determined to the nearest 0.05 kg using a balance scale (Seca 703; Seca, Hamburg, Germany). Blood samples were taken before and immediately after surgery and cytokine concentrations were determined by ELISA. Pain was assessed using a numerical pain rating scale. Adverse effects were collected within the first 24 h after surgery.Results: A total of 6 men and 34 women were included (37.9 ± 10.6 years). Pre-surgery IL-6 and TNF-α serum levels were not detected in study subjects. However, IL-1β levels significantly decreased after surgery (49.58 pg/mL (18.50-112.20)-before surgery vs 13 pg/mL (5.43-22)-after surgery, p = 0.019). IL-6 concentrations were significantly

In Mexico, there is a high mortality rate among patients intubated because of COVID-19. The objective of this study was to investigate the associations of age, comorbidities, and biochemical parameters with the in-hospital mortality of COVID-19 patients. A retrospective study of 79 intubated patients admitted to one hospital in Jalisco, Mexico, between July 2020 and January 2021 was performed. Demographic and clinical characteristics were collected. The mean age was 57.7 (±12.8) years, with 83.5% non-survivors and 16.5% survivors. Age, lactate dehydrogenase (LDH) and D-dimer levels were found to be significantly higher in the non-survivor group (p = 0.011, p = 0.026, p = 0.007, respectively). Patients ≥58 years had a high risk of mortality (OR = 7.017). Significant correlations were also found in some of the study variables: LDH levels and leukocyte count (r = 0.388, p = 0.034) and CRP levels and fibrinogen (r = 0.692, p ˂ 0.001) in the patients ˂58 years. Leukocyte count with LDH levels (r = 0.381, p = 0.024) were significant in the group ≥58 years. No significant difference was observed in the presence of diabetes mellitus (DM) and hypertension. In conclusion, according to logistic regression analysis, age over 58 years represents the main factor associated with mortality in these patients.

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Objective: Identify the incidence of Petersen's hernia in gastric bypass patients at our institution. Summary: Laparoscopic gastric bypass has proved to be the best treatment for obesity and the resolution of their complications, however, it presents long-term complications such as Petersen's hernia. Methods: A retrospective study of a single center, with a total of 225 gastric bypass performed in the bariatric and metabolic surgery clinic of the Hospital Civil de Guadalajara “Dr. Juan I. Menchaca” from January 2014 to March 2020. Results: Of the 225 operated patients, a global follow-up of 80.44% was obtained, with an average postoperative follow-up of 31 (+/-20.92) months, it was found that in 10 patients (4.44%) presented a symptomatic internal hernia. Of these, 9 patients was admitted to the emergency room and 1 detected in the outpatient clinic. These patients presented at the time of surgery a BMI of 27.65 (+/- 5.01) with a percentage of excess weight lost of 62.35% (+/- 25.60). The laparoscopic approach could be completed in 100% of the cases. Regarding hospital stay, an average of 1.1 (+/- 0.31) days was presented. No trans-surgical complications or mortality were reported in the group studied. The mean time between primary surgery and reoperation was 21.3 (+/- 12.98) months. Conclusion: In a 6-year period with a global follow-up of 80.44%, where the Petersen defect was not closed. An incidence of 4.44% was found, with an average follow-up of 31 (+/- 20.92) months. However, the percentage of Petersen's hernia may be underestimated since only those with symptoms that lead the patient to emergency care are usually diagnosed, so a high index of suspicion must always be had.

Background: Anesthetic agents, including opioids can modulate the altered immune function in patients with obesity through mechanisms that involve the expression and release of cytokines. For this reason, anesthetic care in patients with obesity remains controversial. Therefore, the aim of the study was to compare the effect of opioid-containing anesthesia vs opioid-free anesthesia using the Cortínez-Sepúlveda model on serum levels of IL-6, IL-1β and TNF-α before and after surgery in obese patients undergoing bypass surgery.Methods: A randomized cross-sectional study of 40 unrelated obese adults was performed at the Civil Hospital of Guadalajara “Dr. Juan I. Menchaca”. Before undergoing laparoscopic Roux-en-Y gastric bypass, patients were randomly assigned to two anesthesia groups: opiod-containing (n=20) or opiod-free (n=20). The opioid used in the opioid-containing anesthesia group was fentanyl. To characterize the disposition of intravenous propofol for the target-controlled infusion technique in obese patients, the Cortínez-Sepúlveda pharmacokinetic model was used. Body mass was determined to the nearest 0.05kg using a balance scale (Seca 703; Seca, Hamburg, Germany). Blood samples were taken before and immediately after surgery and cytokine serum levels were determined with ELISA kits. Pain was assessed using a numerical pain rating scale. Adverse effects were collected 24 h after surgery.Results: 6 men and 34 women were included in this study (37.9±10.6 years). Pre-surgery IL-6 and TNF-α serum levels were not detected in all participants. However, IL-1β levels significantly decreased after surgery (49.58pg/mL (18.50-112.20)-before surgery vs 13pg/mL (5.43-22)-after surgery, p=0.019). IL-6 concentrations were significantly higher in subjects who received opioid-containing anesthesia (with fentanyl) compared to subjects with opioid-free anesthesia (224.5pg/mL (186.3-262.8) vs 99.5pg/mL (60.8-138.2), respectively, p<0.001; adjusted by age, gender, and BMI). In addition, the use of opioids confers an increased risk for higher IL-6 levels in obese patients (OR=2.95, 95% CI: 1.2-7.2, p=0.010). A linear regression model showed that the operative time (in hours) of bypass surgery and anesthetic technique were positively correlated with IL-6 levels.Conclusion: Anesthesia with opioids was positively related to IL-6 serum levels in obese patients undergoing bypass surgery. This finding could have clinical relevance when choosing an appropriate anesthetic management plan for bariatric surgical patients. Trial registration: The study was retrospectively registered at ClinicalTrials.gov Identification Number: NCT04854252, date 22/04/2021.