Sedation Considerations for the Nonintubated Obese Patient in Critical Care

Welliver, Mark; Bednarzyk, Michele S.

doi:10.1016/j.ccell.2009.07.001

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…This may be related to existing mechanical chest wall compliance alterations, lower functional residual capacity, existing obstructive sleep apnea, or the pickwickian syndrome (2,3). Although true for all patients, minimizing sedation in the ICU may be of particular importance in the patients with morbid obesity to reduce respiratory-related complications, which are the most common postoperative complications experienced by the patients with morbid obesity (4 -7).…”

Section: General Considerations Sedation and Relaxationmentioning

confidence: 98%

Difficulties in managing the surgical patient who is morbidly obese

King

Velmahos

2010

Critical Care Medicine

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Managing patients who are morbidly obese in the intensive care unit is associated with a variety of problems uncommonly experienced with the those who are not morbidly obese. Clinicians experience a myriad of unique problems and circumstances, from the need for special beds and lifts to unusual and unknown volumes of distribution resulting in unclear drug dosing. This review examines several issues including sedation, invasive monitoring, venous thromboembolism prophylaxis, surgical infections, nutritional support, and other complications that may be of particular importance to the critically ill patient who is morbidly obese. In many cases, care is altered based on the complicating issues surrounding morbid obesity. In other cases, the presence of obesity suggests no alterations in our routine critical care delivery. A comprehensive review of the literature is undertaken, data are critically considered, and overall opinion is rendered based on the available peer-reviewed literature. In many cases, data are not available that address the specific patient population in question, so related papers (like gastric bypass data) are considered. Many issues do not have definitive answers based on randomized controlled trials, and much is left to treating clinician opinion and local practice patterns. Where good data exist, however, one should consider carefully and individually deviation from the evidence-based approach.

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Section: General Considerations Sedation and Relaxationmentioning

confidence: 98%

Difficulties in managing the surgical patient who is morbidly obese

King

Velmahos

2010

Critical Care Medicine

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“…На первый план у подобной категории пациентов выступают осложнения респираторного характера. Прежде всего к ним относится нарушение функциональной способности дыхательных мышц, снижение функциональной остаточной емкости легких, ограничение выдоха, гиперкапния, повышенная частота дыхания в состоянии покоя, повышенное сопротивление верхних дыхательных путей со склонностью к развитию обструктивного синдрома апноэ, гиповентиляционный синдром, сопровождающийся легочной гипертензией и правожелудочковой сердечной недостаточностью [15,16].…”

Section: результаты и обсуждениеunclassified

Клинические Аспекты Процедурной И Послеоперационной Седации

Лоскутов¹

2021

ЕМ

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Статья посвящена вопросам интра- и послеоперационной седации хирургических пациентов. На основании результатов исследования по поисковым интернет-системам «Google» и «PubMed», с введением ключевых слов: «процедурная анальгезия», «процедурная седация», «послеоперационное обезболивание», автор проводит обзор основных направлений и современных подходов в процедурной и послеоперационной седации. В работе приводятся исследования различных авторов по данной проблематике. На примере различных групп пациентов проводится анализ положительных и отрицательных сторон послеоперационной седации. В данном обзоре также освещается концепция мультимодальной анальгезии для лечения послеоперационной боли и приводятся различные комбинации ее клинического использования. Особое внимание в статье уделяется дексмедетомидину, описываются различные аспекты его клинического использования, механизм действия, рассматриваются отличительные особенности препарата. В конце обзора автор делает вывод, что использование описанной сбалансированной тактики процедуральной и постоперационной анальгезии и седации при проведении хирургических процедур, диагностических манипуляций и оперативных вмешательств целесообразно внедрять в протоколы отечественных клиник, что, несомненно, будет способствовать стандартизации подходов и улучшению качества ведения больных.

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“…Notable among these are deleterious effects of obesity on the respiratory system, where the following difficulties may be encountered [7]. Impaired function of respiratory muscles, diminished functional residual capacity and limitation of expiratory flow [8,9]. …”

Section: Reviewmentioning

confidence: 99%

“…Impaired function of respiratory muscles, diminished functional residual capacity and limitation of expiratory flow [8,9]. …”

Section: Reviewmentioning

confidence: 99%

Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development

Aantaa

Tonner

Conti

et al. 2015

Multidiscip Respir Med

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BackgroundWe offer some perspectives and commentary on the sedation of obese patients in the intensive care unit (ICU).DiscussionSedation in morbidly obese patients should conform to the same broad principles now current in ICU practice. These include a general presumption against benzodiazepines as first-line agents. Opioids should be avoided in any situation where spontaneous breathing is required. Remifentanil is the preferred agent where continuous stable opioid levels using an infusion are required, because of its lack of context-sensitive accumulation. Volatile anaesthetics may be an option for the same reason but there are no substantial, controlled demonstrations of effectiveness/safety in short-term use in the ICU setting. Propofol is a valuable resource in the morbidly obese patients but the duration of continuous sedation should not exceed 6 days, in order to avoid propofol infusion syndrome. Alpha-2 agonists offer a range of theoretically positive features for the sedation of morbidly obese patients, but at present there is a lack of pharmacokinetic data and a critical mass of high-grade clinical data. Dexmedetomidine has the attraction of not causing respiratory depression or obstructive breathing during sedation and its sympatholytic effects should help deliver stable blood pressure and heart rate. Ketamine has a poor tolerability profile in adults so its use in the ICU context is largely confined to paediatrics.ConclusionNone of the agents currently available is ideal for every situation encountered in the management of morbidly obese patients. This article identifies additional research needed to place sedation practice of obese patients on a more systematic footing.

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Sedation Considerations for the Nonintubated Obese Patient in Critical Care

Cited by 6 publications

References 23 publications

Difficulties in managing the surgical patient who is morbidly obese

Difficulties in managing the surgical patient who is morbidly obese

Клинические Аспекты Процедурной И Послеоперационной Седации

Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development

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