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Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Clinical examination of obese people should be directed to identifying associated comorbid conditions (Table 11.17) and clinical features of disorders causing secondary obesity (see Table 11.15). Obesity may present with symptoms of these comorbid conditions. An assessment of the mental state should be included; morbidly obese people have higher rates of anxiety and depression. Breathlessness may be due to the increased work associated with walking with an increased mechanical weight load and compounded by lack of physical fitness. Consider other causes of breathlessness, including obesity hypoventilation syndrome. Body temperature regulation is more difficult in the obese because of the insulating effect of fat causing problematic sweating. Ascites may present as ‘obesity’ and should be considered as a differential diagnosis in people with an increasing waist size.
Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
The “obesity-hypoventilation syndrome” (OHS) is the combination of chronic hypoventilation with chronic hypercapnia and obesity. Right ventricular dysfunction, due to elevated pulmonary arterial pressures and left heart dysfunction, is commonly present in patients with OHS.
Sleep disordered breathing
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
J. J. Koo, A. Gohari, S. R. Pendharkar, N. T. Ayas
The Pickwick trial was the largest long-term randomized controlled trial of patients diagnosed with obesity hypoventilation syndrome (OHS) and severe OSA (AHI ≥ 30), randomizing stable patients to noninvasive ventilation (NIV) or CPAP at 16 tertiary hospitals in Spain. The study has previously shown no significant difference in hospital resource utilization, blood pressure, cardiovascular events, mortality, respiratory function and quality of life in NIV versus CPAP.23 A follow-up study from this year studied echocardiographic changes in 215 participants (115 allocated to CPAP and 100 allocated to NIV) over a median-follow up of 3 years.24 Although systolic pulmonary artery pressure decreased from baseline for both groups (from 41 mm Hg at baseline to 35 mm Hg with CPAP, and from 42 mm Hg to 36 mm Hg with NIV), there was no significant difference between the groups. There was a similar improvement in left ventricular (LV) diastolic function for both groups but neither showed improvement in LV ejection fraction, LV hypertrophy or right ventricular systolic function. Post-hoc cost effective analysis from the Pickwick trial was also published this year and showed that CPAP was more cost-effective than NIV for patients with severe OSA and OHS.25
Sleep disordered breathing
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Perioperative management of OSA and obesity hypoventilation syndrome (OHS) patients remains a substantial problem. Previous studies and systematic reviews have suggested that OSA is a risk factor for postoperative cardiovascular and respiratory complications.14 A recent large multi-center prospective cohort study with standardized preoperative diagnostic test and follow up assessment by Chan and colleagues has verified the inherent perioperative risks of OSA. In their study, severe OSA was associated with increased 30-day postoperative cardiovascular complications in patients undergoing major noncardiac surgery (30.1% for patients with severe OSA, 14.2% for patients with no OSA).15 Given the strikingly high prevalence of OSA in the general population, further research is urgently needed to determine which interventions (eg, CPAP, additional monitoring) could mitigate these risks.
Deep versus moderate neuromuscular block in laparoscopic bariatric surgeries: effect on surgical conditions and pulmonary complications
Published in Egyptian Journal of Anaesthesia, 2019
Mohamed M. Abu Yazed, Sameh Abdelkhalik Ahmed
The introduction of neuromuscular blocking agents in anesthesia has been associated with numerous benefits. It specifically improves the intubation condition, increases the depth of anesthesia, decreases airway edema, and improves surgical exposure [1–3]. Despite that, it has also been associated with several drawbacks, such as postoperative dysfunction of respiratory muscles that predispose to postoperative pulmonary complications [4,5]. The risk of postoperative respiratory complications increases significantly in morbidly obese patients, sometimes approaching 100% incidence, especially with increasing body mass index (BMI) and presence of obesity hypoventilation syndrome [6]. Respiratory complications must be considered and properly managed in the perioperative management of bariatric surgeries, as they account for about 12% of mortality rates [7].