Obese patients have a significantly higher risk of postoperative myocardial infarction, wound infection, nerve injury, and urinary infection. Obesity is an independent risk factor for perioperative morbidity, and morbid obesity is a risk factor for mortality.

Experimental aspiration pneumonitis studies in general have focused on the pathogenesis of the acidic component of the lung injury, although the injury produced by the particulate component of gastric contents largely has been ignored. The present study compares the inflammatory potential of small gastric particles to acidic lung injury and examines their interaction. Washed and filtered rat gastric food particles, 2-30 mu were resuspended in saline/HCl, pH = 5.3 or 1.25 at different particle densities and instilled intratracheally into anesthetized rats. Nonlethal lung injury was assessed at different times postaspiration by measuring changes in lung permeability and histology. Maximal survival after lung injury in this model occurred at a particle concentration of 40 mg/mL and at a volume of 1.5 mL/kg. Under these conditions, the alveolar capillary leak was less severe during the first 4 h after injury than that seen with a maximal nonlethal acidic injury (1.5 mL/kg, pH = 1.25). However, after 4 h postinjury the alveolar capillary leak increased to levels that were no different from the acidic injury. When the small gastric food particles were suspended in saline/HCl, pH = 1.25, the alveolar capillary leak was increased synergistically. Intratracheal instillation of inert, 10 mu (glass) particles, 40 mg/mL at 1.5 mL/kg, did not result in an increase in lung injury or interact additively or synergistically with acidic saline. Histologically, the small gastric particle injured lungs were associated with focal inflammatory changes as the acidic damage was diffuse.(ABSTRACT TRUNCATED AT 250 WORDS)

The most basic goal of anaesthetists and intensivists is to assure that there is an adequate supply of oxygen to the mitochondria throughout the body to maintain aerobic metabolism and cellular function. The determination of adequate oxygenation has historically been monitored by the absence of organ dysfunction because techniques were not available to assess quantitatively the oxygenation of tissues. Over the past 40 years, measurement and monitoring methods have been developed to first quantitate oxygen supply and more recently to continuously asess both invasively and noninvasively the oxygenation of blood and tissue.' This article will review the current status of the invasive and noninvasive techniques for monitoring oxygenation. Oxygen tension measurement

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