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العنوان
Management of Postoperative Complications in Morbidly
Obese Patients after Bariatric Surgery in ICU /
المؤلف
Karoub, Ahmad Samir Abd Elaziem.
هيئة الاعداد
باحث / Ahmad Samir Abd Elaziem Karoub
مشرف / Mohsen Abd El ghany Bassiony
مشرف / Waleed Abd Elmagid Altaher
مناقش / Hoda Shokri Abd Elsamie
تاريخ النشر
2013.
عدد الصفحات
95 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
العناية المركزة والطب العناية المركزة
تاريخ الإجازة
1/1/2013
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم الرعاية المركزة والتخدير
الفهرس
Only 14 pages are availabe for public view

from 95

from 95

Abstract

SUMMARY
67
SUMMARY
Morbid obesity is now an important problem allover the world due to its
multiple co-morbidities and its marked harmful effect on the lifestyle of the
patient.
The reasons for obesity are multiple and complex.There are many
factors that contribute to the development of obesity including genetic,
hereditary, environmental, metabolic and eating disorders. There are also
acquired causes of obesity as intake of steroids and hypothyroidism.
Severely obese individuals have a greater risk of coronary artery
disease, hypertension, type II diabetes mellitus, sleep apnea, pulmonary
embolism. The difficulty in recognizing the signs and symptoms of
peritonitis puts the obese patient at a greater risk of intra-abdominal sepsis.
Premature death is, therefore, more common in severely obese individuals.
Treatment possibilities include diet restriction, behavioral therapy,
medical treatment and surgery. All non surgical treatment regimens have an
extremely high rate of failure and surgery is therefore today the option for
morbid obesity.
Surgical treatment for obesity has proved that it is the best and most
effective, durable means of preventing the life-threatening complications. Safe
and effective surgical treatment methods increase life expectancy and quality for
patients with extreme excess weight. The sickest ones are the ones who benefit
the most, but they are also the highest risk.
Primary laparoscopic bariatric operations are preferred over the open
procedures because of the reduced complications, wound infections,
pulmonary and thromboembolic complications, reduced rate of incisional
hernias, and decreased hospitalization.
Excellent surgical outcomes require the appropriate selection of
patients, thorough preoperative preparation, technically well-performed
operations, and attentive postoperative care.
Management of patients following bariatric surgery includes routine
postoperative care, such as oxygenation and hemodynamic monitoring, pain
management, mobilization, wound care, nutrition therapy, education, and
emotional support.
SUMMARY
68
Because of the growing number of indications and performance of
bariatric surgeries, more obese patients are being admitted to the ICU.
Sometimes, complications at the intra and postoperative of primary bariatric
surgery or even presence of severe comorbidities may require intensive care,
elective or emergency.
Among factors predisposing to admission in the ICU are mentioned:
male gender, age ≥ 50 years BMI ≥ 60 Kg/m2, diabetes mellitus, OSAS,
cardiopathies, venous difficulty and complications in the intra or immediate
postoperative mainly due to respiratory complications such as pneumonia,
thromboembolic disease, sepsis, respiratory failure requiring mechanical
ventilation and to a lesser extent, respiratory arrest.
Because of the increasing numbers of bariatric surgeries, the risk of
developing postoperative complications is also increased. So, an unusual
postoperative abdominal pain, left shoulder tip pain, vomiting, or asense of
impending doom should all be a call to action as should tachycardia,
tachypnea, or oliguria.
The increase in the number of bariatric procedures annually suggests
that these patients will constitute an increasing portion of obese patients who
require hospital and intensive care. A knowledge of the type of bariatric
operation performed and an understanding of its anatomy and physiology are
useful to provide optimal care for these patients, particularly when
considering potential complications and their diagnosis and treatmen.
Lastly, Obese patients, many of whom are now bariatric surgical
patients, constitute an increasing percentage of critically ill patients. Obesity
is characterized by a chronic proinflammatory state, changes in cellular
immunity, hypercoagulability, and insulin resistance. These baseline
physiologic derangements, coupled with the stress of critical illness, present
unique challenges to the critical care team. Knowledge of the
pathophysiology of obesity and of the presentation and treatment of serious
complications of bariatric surgery are necessary to manage these patients
effectively.