Improvement of associated respiratory problems in morbidly obese patients after open Roux-en-Y gastric bypass.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is present in 44% of patients scheduled for bariatric surgery. Respiratory dysfunction associated with this syndrome is attributable to chronic obstructive pulmonary disease (COPD) and/or obesity hypoventilation syndrome (OHS). We studied the long-term effect of bariatric surgery on weight loss, on the respiratory comorbidities associated with obesity, and on the need for non-invasive positive pressure ventilation. METHODS: We followed a sample of patients with respiratory co-morbidity scheduled for open Capella Roux-en-Y gastric bypass (RYGBP) over 5-years. Patients who were positive for polysomnographic studies and required continous positive airway pressure (CPAP) before surgery were included. All patients were subjected to the same anesthetic and surgical protocols. At 1 year after surgery, polysomnographic studies were performed and arterial blood gases and pulmonary function were tested. RESULTS: Of the 209 patients scheduled for bariatric surgery during the study period, 105 had respiratory co-morbidity. Of these, 30 required CPAP-BiPAP treatment before surgery and were included in our study. Surgery took 128 minutes (range 70 to 210 minutes). Tracheal extubation in the operating theater was possible for 26 patients (86.7%). During the early postoperative period, 7 patients (23.3%) presented respiratory complications. Length of hospitalization was 6.87 days (range 4 to 11 days). At 1 year after RYGBP, patients presented significant weight loss and improvement of hypoxemia (from 73.3 +/- 10.6 to 90.5 +/- 11.5, P = 0.000), hypercarbia (from 44.5 +/- 5.7 to 40.6 +/- 4.9, P = 0.005), and in spirometric (P = 0.004) and polysomnographic results (P = 0.001). CPAP-BiPAP treatment after weight loss was necessary in only 14% of patients (P = 0.001). CONCLUSIONS: Weight loss after RYGBP improved arterial blood gases, respiratory tests and polysomnographic studies. CPAP treatment can be withdrawn in most patients.

[Influence of the severity of obesity on morbidity and mortality after gastric bypass surgery]. / Influencia del grado de obesidad en la morbimortalidad operatoria de la cirugia bariátrica.

OBJECTIVE: To determine the influence of severity of obesity on morbidity and mortality following Roux-en-Y gastric bypass and vertical ringed gastroplasty, with severity classified as morbid obesity (MO) defined by a body mass index (BMI) between 35 and 55 Kg/m2 and super-morbid obesity (SMO) defined by a BMI exceeding 55 Kg/m2. METHOD: A series of patients who underwent the aforementioned type of gastric bypass surgery were followed for 5 years. The patients were classified as to whether they had associated sleep apnea syndrome, alveolar hypoventilation, or "overlap syndrome". RESULTS: A total of 105 patients were enrolled: 70 (66.7%) classified as having MO and 35 (33.3%) classified as having SMO. Distribution by sex was significantly different in the 2 groups, but respiratory diseases were similar. PaO2 was higher in the MO group, PaCO2 was lower, and the alveolar-arterial gradient was smaller. Duration of surgery was shorter in the MO group (120.43 +/- 32.97 vs. 136.76 +/- 28.28 minutes). The percentage of complications was similar in the 2 groups (32.86% and 45.7% in the MO and SMO groups, respectively), although the incidence of respiratory complications was higher in SMO patients (8.57% vs. 20% in the MO and SMO groups, respectively). No differences were observed in the rates of surgical, hemodynamic, or infectious complications. Length of hospital stay was similar (6.44 vs. 6.69 for MO and SMO patients, respectively). CONCLUSIONS: More severe obesity can be associated with preoperative arterial blood gas alterations in patients with concomitant respiratory disease and a higher incidence of respiratory complications in the early phase of recovery from gastric bypass surgery.

[Spontaneous closure of a intracraneal dural arteriovenous fistula by controlled hypotension during a general anesthesia procedure. A case report]. / Cierre espontáneo de fístula arteriovenosa dural intracraneal tras hipotensión controlada bajo anestesia general. A propósito de un caso.

Intracranial dural arteriovenous fistulas (DAVF) are arteriovenous communications within the duramater, which seem to be pathophysiologically related to a venous sinus thrombosis. DAVF may require invasive treatment, although rarely spontaneous occlusion has been reported. The present case is a 48-year-old male with a diagnosed type III DAVF of the right lateral sinus. Complete endovascular embolization was not possible to perform, so he was considered a candidate for surgical treatment. During perioperative management, under general anesthesia, the intraoperative arteriographyc monitoritation showed a spontaneous closure of the DAVF after induced controlled hypotension, resulting in complete cure. We conclude that controlled hypotension could become an alternative for treatment of DAVF in high risk patients or when there is no chance for embolization.patients or when there is no chance for embolization. Neurología 2003;18(10):746-749

Cierre espontáneo de fístula arteriovenosa dural intracraneal tras hipotensión controlada bajo anestesia general. A propósito de un caso / Spontaneous closure of a intracraneal dural arteriovenous fistula by controlled hypotension during a general anesthesia procedure. A case report

Las fístulas arteriovenosas durales intracraneales (FAVD) son comunicaciones arteriovenosas localizadas en la duramadre, cuya fisiopatología parece estar relacionada con la trombosis de un seno. Algunas evolucionan espontáneamente a la trombosis y en consecuencia a la curación, mientras que otras precisan de tratamientos invasivos en forma de embolizaciones o cirugía que no siempre son posibles de realizar técnicamente, o suponen un elevado riesgo para el paciente. Presentamos el caso de un varón de 48 años diagnosticado de una fístula arteriovenosa en seno lateral derecho tipo III, cuya embolización no fue posible, por lo que fue propuesto para abordaje quirúrgico mediante craneotomía, y que en el contexto de la preparación intraoperatoria, con control angiográfico directo, bajo anestesia general, y sometido a hipotensión controlada, presentó cierre de la fístula espontáneo, con curación completa. Se concluye que la hipotensión controlada, podría constituir una alternativa al tratamiento de estas fístulas en los casos de alto riesgo o imposibilidad de embolización (AU)

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