Perioperative evaluation of the obese patient

Donohoe, Claire L.; Feeney, Ciara; Carey, Michael; Reynolds, John V.

doi:10.1016/j.jclinane.2011.06.005

Cited by 29 publications

(21 citation statements)

References 177 publications

(165 reference statements)

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“…This decrease in CI continues postoperatively in obese individuals, whereas it returns to baseline in nonobese control patients. 1,9 The physiologic changes induced by obesity, such as the decrease in CI, can significantly affect the distribution, binding, and elimination of anesthetic drugs. The alterations in pharmacokinetics can lead to severe adverse events if dosing is based solely on the actual body weight.…”

Section: Management Of Anesthesia Of the Obese Patient Inductionmentioning

confidence: 99%

“…13 In addition, the mass effect of intra-abdominal adipose tissue contributes to the decrease in respiratory compliance. 1 These changes are further affected by anesthesia and surgical procedures. 4 Changes in ventilation, such as a reduction in the FRC, expiratory reserve volume, and total lung capacity are frequent observations of the clinically obese.…”

Section: Maintenancementioning

confidence: 99%

“…14 The FRC exponentially decreases with increasing total body weight. 1 Under anesthesia, lean people have a decrease in FRC by 20%, whereas obese people have a 50% decrease in FRC. 1 The low FRC and expiratory reserve volume contribute to rapid desaturation with apnea (as is often seen on anesthetic induction) or hypoventilation and air trapping with poor lung function.…”

Section: Maintenancementioning

confidence: 99%

“…Ultimately, increased left heart diastolic filling and left ventricular hypertrophy can occur (Table 9.1). 1 Adipose tissue is a major source of inflammatory mediators, and obesity is, therefore, linked to chronic low grade inflammation. 8 The chronic inflammation observed in obese humans is thought to be one of the significant links between obesity and cardiovascular disease.…”

mentioning

confidence: 99%

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Nutritional Disease

Snyder

2014

Canine and Feline Anesthesia and Co‐Existing Disease

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The World Health Organization's definition of obesity is an abnormal or excessive fat accumulation in adipose tissue to the extent that health is impaired. 1 -3 An excess of adipose tissue occurs when the caloric intake surpasses the caloric expenditure. 4 Owing to the prevalence of obesity in the human population, the World Health Organization has classified obesity into simple obesity (body mass index [BMI] 30-34.9 kg m −2 ), severe obesity (35-39.9 kg m −2 ), morbid obesity (40-49.9 kg m −2 ), and super morbid obesity (≥40 kg m −2 ). 5 PathophysiologyObesity is the most common medical condition in companion animals and is associated with a number of comorbidities. 2 Approximately 55% of dogs and 53% of cats in the USA are considered to be overweight or obese. 6 Worldwide, 22-40% of dogs are considered to be obese. 2 Coincident with obesity in humans comes an increase in morbidity, such as diabetes and musculoskeletal conditions. 6 The criteria for obesity are not as clear-cut in veterinary patients as with human patients, as optimal body weights have not been established for our species and varying breeds. However, it is still concluded that when a patient's weight is 15% above normal for its breed, it is "overweight," and when a patient's weight is 30% above normal, it is "obese." 2 Risk factors for the development of obesity in veterinary patients have been identified. There is a link between certain breeds and their genetic predisposition for obesity. genetically predisposed to obesity. Likewise, particular breeds appear to be resistant to obesity, such as the sight hound group. 2 Aging is associated with an increase in the likelihood of obesity. With aging, the lean body mass decreases, resulting in a decrease in the total daily energy needs of the animal. In conjunction with a decrease in total daily energy needs, the animal's voluntary activity is typically decreased, possibly because of comorbidities of aging, such as osteoarthritis. The decrease in total daily energy needs combined with a decrease in activity can lead to weight gain if caloric intake is not decreased as well. 2 Excessive weight can have a major impact on the overall health of the animal. In humans, morbid obesity (BMI of ≥ 40-44.9 kg m −2 ) is associated with an increased likelihood of diabetes mellitus, 7 respiratory failure, hypertension, left ventricular hypertrophy, atherosclerosis, myocardial ischemia, and some forms of cancer compared to nonobese patients. 4 Mild to moderate hypertension is described in up to 60% of obese human patients, whereas 5-10% of obese human patients have severe hypertension. With time, hypertension can lead to left ventricular dilation, increased left ventricular wall stress, compensatory left ventricular hypertrophy, and left ventricular diastolic dysfunction. 4 An increase in body adipose tissue alters cardiopulmonary physiology, leading to an increase in cardiac output (CO), oxygen consumption, and closing capacity and a decrease in functional residual capacity (FRC). In humans, these alterations ca...

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Section: Management Of Anesthesia Of the Obese Patient Inductionmentioning

confidence: 99%

Section: Maintenancementioning

confidence: 99%

Section: Maintenancementioning

confidence: 99%

mentioning

confidence: 99%

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Nutritional Disease

Snyder

2014

Canine and Feline Anesthesia and Co‐Existing Disease

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“…Obese patients are always challenging for anesthesiologists [1][2][3]. The effect of obesity and its associated comorbidities, such as hypertension, diabetes, dyslipidemia and obstructive apnea syndrome, induce a different spectrum of pathologies [4,5].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Transthoracic Echocardiography is a Feasible Technique Used in Morbidly Obese Patients for Non-Invasive Cardiovascular Monitoring

Schulmeyer¹,

Maza²,

Fernandez³

2016

J Anesth Clin Res

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Background and objectives: To evaluate the feasibility of an abbreviated focus-assessed transthoracic echocardiography protocol in morbidly obese patients. The purpose of this study was to evaluate whether good images could be obtained from this particularly difficult group of patients for whom acoustic imaging is often poor. Heart imaging could be helpful for cardiopulmonary screening and real-time monitoring.

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Nutritional Disease

Snyder

2021

Canine and Feline Anesthesia and Co‐Existing Disease

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Perioperative evaluation of the obese patient

Cited by 29 publications

References 177 publications

Nutritional Disease

Nutritional Disease

Intraoperative Transthoracic Echocardiography is a Feasible Technique Used in Morbidly Obese Patients for Non-Invasive Cardiovascular Monitoring

Nutritional Disease

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