Morbid Obesity: Peri-operative Management by Adrian Alvarez, Jay B. Brodsky, Hendrikus J. M. Lemmens,

By Adrian Alvarez, Jay B. Brodsky, Hendrikus J. M. Lemmens, John M. Morton

The area is experiencing an weight problems epidemic. In either industrialized and rising international locations, the proportion of adults and kids with weight problems is expanding each year. it truly is now not strange to come across a sufferer with severe or morbid weight problems within the working room; those sufferers are usually scheduled for all types of surgery. each person excited by the peri-operative administration of the surgical sufferer with morbid weight problems - surgeons, anesthesiologists, internists, psychologists, nurses, nutritionists, respiration therapists - needs to be conscious of the specified wishes of those sufferers. Morbid weight problems: Peri-operative administration, moment version, considers the perioperative care of the morbidly overweight sufferer, from preoperative guidance to intraoperative administration and during to their postoperative direction. Edited via best specialists within the administration of the morbidly overweight surgical sufferer, Morbid weight problems: Peri-operative administration, moment variation, presents transparent, functional medical tips at the administration of the tremendous overweight surgical sufferer.

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4 Insulin resistance, diabetes mellitus type 2, and cardiac dysfunction 14 Excess AVF is commonly associated with insulin resistance, impaired glucose tolerance, and type 2 diabetes. Type 2 diabetes is associated with the genesis of atherosclerosis, CHD, stroke and, independent of MO, commonly results in insulin resistant cardiomyopathy [60]. Abdominal obesity is accompanied by a state of chronic low-grade inflammation, characterized by increased production of pro-inflammatory adipokines, which play a role in the development of atherosclerosis and insulin resistance.

56. Artz M, Bradley TD. Treatment of sleep apnea in heart failure. Am J Respir Crit Care Med 2006; 173: 1300–8. 57. Ikonomidis I, Mazarakis A, Papadopoulos C, et al. Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study. J Hypertens 2007; 25: 439–47. 58. Good D, Morse SA, Ventura HO, et al. Obesity, hypertension, and the heart. J Cardiometab Syndr 2008; 3: 168–72. 59. Gonzaga CC, Calhoun DA.

1 Introduction Complex changes to pulmonary function and physiology occur with increasing obesity. Depending on the degree of obesity present and the distribution of adipose tissue, these changes lead to alterations in pulmonary gas exchange, and, ultimately, contribute to cardiovascular changes and morbidity. Obesity is also linked to sleep disordered breathing syndromes, most commonly obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). This chapter summarizes current knowledge about changes in pulmonary physiology associated with obesity and describes the pathophysiology of OSA and OHS.

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