Morbidly Obese Patients Research Articles

Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese end-stage liver disease patients: The LT-SG study.

In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading aetiology of end-stage liver disease and hepatocellular carcinoma. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) has been proposed in the US, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for LT at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were: i) safety expressed as 30- and 90-days overall survival (OS) and ii) major postoperative complications (Clavien-Dindo > IIIa). The secondary outcome was efficacy expressed as a 3-year %excess BMI loss(%EBMIL). Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38-48). Indications to LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (ET-DRI>1.6). The 30 and 90-day OS were 63.6% and 54.5%, respectively. All deaths occurred in patients with p-SOFT>15 or in patients who had at least three of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD>25 or ET-DRI >1.6. The six months, 1, 2 and 3 years %excess BMI loss was 73%, 60%, 50% and 43%, respectively. LT-SG is a complex procedure thatmay carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended and prioritization of severely obese patients on the waiting list should be considered.

Obesity and its impact on functional capacity: understanding the interplay for health management

Abstract Background Cardiopulmonary exercise testing (CPET) plays a significant role in evaluating obese individuals due to the unique physiological challenges they face during exercise. As diastolic function is impaired in majority of morbidly obese pts, combination of CPET with diastolic stress echocardiography may add more information to objective assessment Objective To assess the value of combined stress echo CPET (ESE-CPET) in assessment of diastolic function in morbidly obese pts. Methods We studied 400 pts (74% female, age 39.2±9.9 years) referred for bariatric surgery. Echocardiographic measurements have been performed before CPET and immediately after the test. CPET was performed on treadmill (maximal Bruce) with breath-by-breath gas analysis. We measured both peak oxygen consumption (peakVO2) and VO2 at anaerobic threshold (AT), as well as other ventilatory and hemodynamic parameters. Results Mean BMI was 44± kg/m2. Left ventricular ejection fraction was 63.5±5.6%. Mean VO2 at AT was 17±2 ml/kg/min, mean Peak VO2 was 19±4 ml/kg/min. Resting eho : mitral E to A wave (E/A),deceleration time ( Dt) and mitral E to mitral anular E’ (E/E’) values did not correlate significantly with parameters of CPET. However, there was significant correlation between maximal E/ E’ with PeakVO2 and VO2 at AT (p<0.001), , Pet CO2 (p=0.0001) as well as with myocardial performance index as a parameter of global left ventricular function (p<0.001) However, VE/VCO2 was the strongest predictor of increase in E/ E’≥ 15 indicating the importance of ventilatory parameters and dynamic tests. Conclusions Assessment of diastolic function in morbid obese patients represents a great challenge to cardiologists because obesity contributed significantly to deterioration of diastolic function. Combined stress echo CPET showed the advantage and benefit of integrated evaluation of both pulmonary and cardiovascular function representing as a significant step forward in assessment of diastolic function overcoming the limitations of resting echocardiography and CPET performed as a single test.

TCT-649 Mortality Is Lowest in Overweight Followed by Obese and Morbid Obese Patients and Is Highest in Cachexia Compared With Normal Weight in Patients With a Diagnosis of Aortic Stenosis

TCT-649 Mortality Is Lowest in Overweight Followed by Obese and Morbid Obese Patients and Is Highest in Cachexia Compared With Normal Weight in Patients With a Diagnosis of Aortic Stenosis

Evaluation of Anti-Xa Target Attainment with Prophylactic Enoxaparin Dosing Regimens for Venous Thromboembolism Prophylaxis in Morbidly Obese Patients.

Subcutaneous enoxaparin has been shown to reduce the risk of venous thromboembolism (VTE) among hospitalized patients. However, alternative enoxaparin dosing strategies may be necessary in morbid obesity. The objective of this study was to assess the rate of target anti-Xa attainment with three enoxaparin dosing regimens for venous thromboembolism (VTE) prophylaxis in morbidly obese patients. In this retrospective study, anti-Xa target attainment was assessed among adult patients with a body mass index (BMI) ≥ 40 kg/m2 receiving enoxaparin 40 mg twice daily (BID), 60 mg BID, or 0.5 mg/kg BID. Univariate and multivariate analyses were conducted. Target anti-Xa levels were defined as a steady-state, peak level of 0.2-0.5 IU/mL. This study included 120 patients with 55 patients receiving 40 mg BID, 44 patients receiving 60 mg BID, and 21 patients receiving 0.5 mg/kg BID. Target anti-Xa levels were achieved in 29.1% of patients in the 40 mg BID arm, 54.5% in the 60 mg BID arm, and 90.5% in the 0.5 mg/kg BID arm. Anti-Xa target attainment was significantly increased in both the 60 mg BID arm (p = 0.01) and the 0.5 mg/kg arm (p < 0.0001), compared to the 40 mg BID arm. In morbidly obese patients, weight-based dosing was associated with a greater attainment of target anti-Xa levels. Further studies are needed to determine the impact of these dosing regimens on clinical outcomes.

Alterations of lipid homeostasis in morbid obese patients are partly reversed by bariatric surgery

Besides its beneficial effect on weight loss, gastric bypass surgery (GBS) may impact the circulating levels of phospho- and sphingolipids. However, long-term effects have not been explored. To investigate alterations in lipidomic signatures associated with massive weight loss following GBS, we conducted direct infusion tandem mass spectrometry on serum and subcutaneous adipose tissue (SAT) samples collected in a longitudinal cohort of morbid obese patients prior to GBS and 1 year following the surgery. A tissue-specific rearrangement of 13% among over 400 phospholipid and sphingolipid species quantified in serum and SAT was observed 1 year following GBS, with a substantial reduction of ceramide levels and increased amount of hexosylceramides detected in both tissues. The comparison of these new lipidomic profiles with the serum and SAT lipidomes established from an independent cohort of lean and morbid obese subjects revealed that GBS partly restored the lipid alterations associated with morbid obesity.

MiR-146a rs2910164 (G/C) variant may predict morbid obesity risk in adults

Obesity is a common public health problem associated with serious, life-threatening complications. MicroRNAs (miRs) have modulating roles in the immune and inflammatory systems. Therefore, this study aimed to analyze the relationship between miR-146a and morbid obesity (MO) in a Turkish population. In this study, a total of 258 subjects (110 patients with MO and 148 controls) were genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to analyze miR-146a rs2910164. Then, we examined the patients as males and females separately. The results of the analyses were evaluated for statistical significance. There was a significant difference in genotype and allele frequencies of miR-146a rs2910164 between patients with MO and control individuals. miR-146a rs2910164 CC genotype and C allele were shown to increase in the MO patients’ group compared to the control group (p = 0.000, p = 0.000, respectively). Also, the C allele was higher in both female and male patients compared to controls (p = 0.000, p = 0.000, respectively). High differences were also observed when the patients and the controls were compared according to CC versus GG + GC and GG versus GC + CC (p = 0.000, p = 0.000, respectively). A significant difference was found between the female/male patients and the female/male controls in terms of GG + GC versus CC (p = 0.000, p = 0.000, respectively). To the best of our knowledge, this is the first study to investigate the relationship between this variant and MO in Turkey. Our results showed that miR-146a rs2910164 is a valuable biomarker that can be used to distinguish between patients with MO and the healthy population. The findings can be extended by increasing the sample sizes with diverse ethnicities.

The Outcome of Metabolic and Bariatric Surgery in Morbidly Obese Patients with Different Genetic Variants Associated with Obesity: A Systematic Review.

Metabolic and bariatric surgery (MBS) effectively treats obesity and related comorbidities, though individual responses vary. This systematic review examines how genetic variants influence MBS outcomes in morbidly obese patients. A comprehensive search in PubMed, Embase, Medline, and the Cochrane Library identified 1572 studies, with 52 meeting the inclusion criteria. Two reviewers independently filtered and selected studies, including relevant cross-references. Research focused on polymorphisms in genes such as UCP2, UCP3, 5-HT2C, MC4R, FKBP5, FTO, CAT haplotypes, LYPAL-1, PTEN, FABP-2, CNR1, LEP656, LEP223, GLP-1R, APOA-1, APOE, ADIPOQ, IL-6, PGC1a, TM6SF2, MBOAT7, PNPLA3, TCF7L2, ESR1, GHSR, GHRL, CD40L, DIO2, ACSL5, CG, TAS2R38, CD36, OBPIIa, NPY, BDNF, CLOCK, and CAMKK2. Most studies explored associations with post-surgery weight loss, while some examined metabolic, cardiovascular, taste, and eating behavior effects as well. Understanding the role of genetic factors in weight loss and metabolic outcomes post-MBS can help tailor personalized treatment plans for improved efficacy and long-term success. Further research with larger sample sizes and extended follow-up is needed to clarify the effects of many genetic variants on MBS outcomes in morbidly obese patients.

Comparative Study Between the Outcomes of Laparoscopic Sleeve Gastrectomy and Mini Gastric Bypass for Morbidly Obese Patients

Comparative Study Between the Outcomes of Laparoscopic Sleeve Gastrectomy and Mini Gastric Bypass for Morbidly Obese Patients

Body mass index is associated with pulmonary gas and blood distribution mismatch in COVID-19 acute respiratory failure. A physiological study.

The effects of obesity on pulmonary gas and blood distribution in patients with acute respiratory failure remain unknown. Dual-energy computed tomography (DECT) is a X-ray-based method used to study regional distribution of gas and blood within the lung. We hypothesized that 1) regional gas/blood mismatch can be quantified by DECT; 2) obesity influences the global and regional distribution of pulmonary gas and blood; 3) regardless of ventilation modality (invasive vs. non-invasive ventilation), patients' body mass index (BMI) has an impact on pulmonary gas/blood mismatch. This single-centre prospective observational study enrolled 118 hypoxic COVID-19 patients (92 male) in need of respiratory support and intensive care who underwent DECT. The cohort was divided into three groups according to BMI: 1. BMI<25kg/m2 (non-obese), 2. BMI = 25-40kg/m2 (overweight to obese), and 3. BMI>40kg/m2 (morbidly obese). Gravitational analysis of Hounsfield unit distribution of gas and blood was derived from DECT and used to calculate regional gas/blood mismatch. A sensitivity analysis was performed to investigate the influence of the chosen ventilatory modality and BMI on gas/blood mismatch and adjust for other possible confounders (i.e., age and sex). 1) Regional pulmonary distribution of gas and blood and their mismatch were quantified using DECT imaging. 2) The BMI>40kg/m2 group had less hyperinflation in the non-dependent regions and more lung collapse in the dependent regions compared to the other BMI groups. In morbidly obese patients, gas and blood were more evenly distributed; therefore, the mismatch was lower than in other patients (30% vs. 36%, p < 0.05). 3) An increase in BMI of 5kg/m2 was associated with a decrease in mismatch of 3.3% (CI: 3.67% to -2.93%, p < 0.05). Neither the ventilatory modality nor age and sex affected the gas/blood mismatch (p > 0.05). 1) In a hypoxic COVID-19 population needing intensive care, pulmonary gas/blood mismatch can be quantified at a global and regional level using DECT. 2) Obesity influences the global and regional distribution of gas and blood within the lung, and BMI>40kg/m2 improves pulmonary gas/blood mismatch. 3) This is true regardless of the ventilatory mode and other possible confounders, i.e., age and sex. Clinicaltrials.gov, identifier NCT04316884, NCT04474249.

The Expression of Genes Related to Reverse Cholesterol Transport and Leptin Receptor Pathways in Peripheral Blood Mononuclear Cells Are Decreased in Morbid Obesity and Related to Liver Function.

Obesity is frequently accompanied by non-alcoholic fatty liver disease (NAFLD). These two diseases are associated with altered lipid metabolism, in which reverse cholesterol transport (LXRα/ABCA1/ABCG1) and leptin response (leptin receptor (Ob-Rb)/Sam68) are involved. The two pathways were evaluated in peripheral blood mononuclear cells (PBMCs) from 86 patients with morbid obesity (MO) before and six months after Roux-en-Y gastric bypass (RYGB) and 38 non-obese subjects. In the LXRα pathway, LXRα, ABCA1, and ABCG1 mRNA expressions were decreased in MO compared to non-obese subjects (p < 0.001, respectively). Ob-Rb was decreased (p < 0.001), whereas Sam68 was increased (p < 0.001) in MO. RYGB did not change mRNA gene expressions. In the MO group, the LXRα pathway (LXRα/ABCA1/ABCG1) negatively correlated with obesity-related variables (weight, body mass index, and hip), inflammation (C-reactive protein), and liver function (alanine-aminotransferase, alkaline phosphatase, and fatty liver index), and positively with serum albumin. In the Ob-R pathway, Ob-Rb and Sam68 negatively correlated with alanine-aminotransferase and positively with albumin. The alteration of LXRα and Ob-R pathways may play an important role in NAFLD development in MO. It is possible that MO patients may require more than 6 months following RYBGB to normalize gene expression related to reverse cholesterol transport or leptin responsiveness.

Method of Diagnosing Sarcopenia in Morbidly Obese Patients

Introduction. Sarcopenia refers to a clinical syndrome characterized by progressive skeletal muscle disease, loss of muscle mass and strength resulting in impaired physical performance. The prevalence of sarcopenia in the population ranges from 5% to 13% in people aged 43.0 ± 11.1 years and reaches 50% in those over 70. Various methods have been used to diagnose sarcopenia, which, however, have their limitations. Currently, CT scanning is considered the most accurate method for the detection of sarcopenia. Therefore, the development of new methods for early diagnosis of sarcopenia appears relevant. Aim. To investigate different methods of diagnosing sarcopenia in morbidly obese patients. Materials and methods. The study presents an analysis of various methods for diagnostics of sarcopenia in morbidly obese patients, including a patented method based on the research conducted in the BSMU Clinic (Utility Patent No. 2815157 dated 11.03.2024). Results and discussion. Doctors used the suggested method of diagnosis, defined the value of sarcopenia index equal or less than 15, and diagnosed sarcopenia. Conclusion. The prevalence and severity of sarcopenia vary depending on the classification criteria and thresholds used. Since a unified diagnostic method is yet to be developed, it is necessary to continue research into this issue, and introduce sarcopenia detection, prevention, and correction techniques into widespread clinical practice. Indices of sarcopenia and obesity, obtained during an additional preoperative study, provide significant prognostic information superior to body mass index, thereby enabling the direction and scope of surgical interventions to be determined and survival outcomes to be improved.

The clinical significance of inflammatory mediators in predicting obesity and progression-free survival in patients with adult-onset Craniopharyngioma

BackgroundCraniopharyngioma (CP) is a rare malformational tumor characterized by high rates of recurrence and morbid obesity. However, the role of inflammatory mediators in obesity and the prognosis of patients with CP remains unknown. Therefore, the present study aimed to analyze associations of inflammatory mediators with weight-related outcomes and the prognosis of patients with CP.MethodsA total of 130 consecutive patients with CP were included in this study. The expression levels of seven inflammatory mediators and the plasma leptin concentration were investigated. Clinical parameters, weight changes, new-onset obesity, and progression-free survival (PFS) were recorded. The relationships between inflammatory mediators, clinicopathologic parameters, weight-related outcomes, and PFS were explored.ResultsCompared with those in normal pituitary tissue, the expressions of inflammatory mediators in tumor tissue were higher. Higher expression levels of CXCL1 and CXCL8 were identified as independent risk factors for significant weight gain, and CXCL1 and TNF were identified as independent risk factors for new-onset postoperative obesity. Poor PFS was associated with higher expression levels of CXCL1, CXCL8, IL1A, IL6, and TNF.ConclusionThe present study revealed that inflammatory mediators are associated with morbid obesity in patients with CP. Inflammatory mediators may be the critical bridge between elevated leptin and weight-related outcomes. Additionally, PFS was associated with the expression of inflammatory mediators. Further research is needed to elucidate the underlying mechanisms of inflammatory mediators and their potential as targets for novel therapies for CP.

Fibro-Scan Based Score and Novel Noninvasive Serum Marker, FGF-21, to Assess Liver Fibrosis in Morbidly Obese Patients

Abstract Background (NAFLD) is currently the most common cause of liver disease in the Western world, affecting up to 20- 30% of the general adult population. It is a growing public health problem, because of the increasing prevalence of the pathologies that contribute to its development such as obesity and inflammation status. Aim of the Work The study is aimed to develop and validate noninvasive scoring system for assessment liver fibrosis in morbidly obese patients with NAFLD. Subjects and Methods This is a Prospective cohort study, was carried out on 50 morbidly obese patients selected from internal medicine department, El Demerdash Hospital, through a period of six months. Results There were 32(64.0%) male and 18(35.0%) female with mean age 40.48 (± 12.16) SD. There were 14(27.0%) between (20 -30), 11(22.0%) between (30-40), 9(18.0%) between (40-50) and 16(32.0%) ≥50. Mean Weight (Kg) was 106.6 (± 13.31) SD with range (82.50 – 145.5), mean Height (Cm) was 171.7 (± 6.25) SD with range (158.0 – 185.0), mean BMI (Kg/m2) was 36.17 (± 4.15) SD with range (29.30–43.40), mean Waistcircumference 113.1 (±7.64) SD with range (92.0 – 129.0). There were 37(74.0%) with Co-morbidity. 10(20.0%) have DM, 11(22.0%) have HTN, 11(22.0%) have CDK and 5(10.0%) have COPD. Conclusion That the combination of Fibroscan and, APRI, FGF-21 and FIB-4 methods provides a valuable approach for assessing liver fibrosis in NAFLD patients. This can eliminate the need for liver biopsy in patients without clear indication. In addition, several recent studies have also validated the used of non-invasive markers in the diagnosis of NAFLD. The establishment of a national program for the recognition of NAFLD is therefore essential to reduce the risk of liver disease progression.

Comparative study of Laparoscopic Sleeve Gastrectomy versus Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI) as a Treatment Modality for Morbidly Obese Patients with Type 2 Diabetes Mellitus

Abstract Background Bariatric surgery has been shown to be the most successful approach in managing morbid obesity that can achieve and sustain great weight loss for a long period. Furthermore, bariatric surgery can achieve better resolution of type 2 diabetes mellitus (T2DM) than intensive medical therapy alone. The present study aimed to compare the effect of Sleeve Gastrectomy (SG) against Single Anastomosis Sleeve Ileal Bypass (SASI) regarding the control of Diabetes Mellitus and weight loss. Patients and Methods This is a prospective comparative study conducted on 60 obese patients (BMI of 30 kg/m2 associated with obesity-related comorbidities including T2DM) to evaluate the effect of SG Versus SASI on obese patients with type II DM. it was carried out in Misr University Hospital from January 2022 to June 2022. This study included 60 patients which are divided randomly into two groups; one group consisted of 30 patients underwent SASI, the other group consisted of 30 patients underwent SG. The main outcome measures were excess weight loss (EWL) and resolution of T2DM at 6 after surgery. Results The results of this study showed that there was no statistically significant difference between both groups regarding EWL (the mean EWL % was 47.39±8.07 &amp; 48.09 ±1.4 for SASI &amp; SG respectively). Improvement in T2DM after SASI was better than SG (80% vs 66.7%, respectively) with no statistically difference between them. SASI required longer operative time than SG (116.83±19.23 versus 60.5 ±9.77, respectively). Complications occurred in 2 (6.7%) patients after SASI and 5 (16.7%) patients after SASI. Conclusion There was a statistically significant effect of SASI and SG on morbidly obese patients with T2DM; improving both obesity and obesity related co- morbidities with no statically significant difference between both groups regarding EWL and Improvement in T2DM after 6 months. So, large sample size with long-term follow-up period should be performed to better evaluate these technical surgeries and their efficacy regarding postoperative weight loss, metabolic changes, and nutritional status of patients.

Difference between Pfannenstiel Incision and High Transverse Supra Umbilical Incision, During Elective Cesarean Section in Morbidly Obese Patients

Difference between Pfannenstiel Incision and High Transverse Supra Umbilical Incision, During Elective Cesarean Section in Morbidly Obese Patients

Comparative study between laparoscopic Sleeve Gastrectomy vs Sasi Operation as a Treatment for Morbidly Obese Patients with Type 2DM

Comparative study between laparoscopic Sleeve Gastrectomy vs Sasi Operation as a Treatment for Morbidly Obese Patients with Type 2DM

Preoperative Laboratory Values Predicting Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Total Hip or Knee Arthroplasty.

Morbidly obese patients are an ever-growing high-risk population undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) for end-stage osteoarthritis. This study sought to identify preoperative laboratory values that may serve as predictors of periprosthetic joint infection (PJI) in morbidly obese patients undergoing THA or TKA. All morbidly obese patients with preoperative laboratory data before undergoing primary elective TKA or THA were identified using the Premier Healthcare Database. Patients who developed PJI within 90 days after surgery were compared with patients without PJI. Laboratory value thresholds were defined by clinical guidelines or primary literature. Univariate and multivariable regression analyses were utilized to assess the association between PJI and preoperative laboratory values, including total lymphocyte count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), albumin level, platelet count, albumin-globulin ratio, hemoglobin level, and hemoglobin A1c. Of the 6,780 patients identified (TKA: 76.67%; THA: 23.33%), 47 (0.69%) developed PJI within 90 days after surgery. The rate of PJI was 1.69% for patients with a hemoglobin level of <12 g/dL (for females) or <13 g/dL (for males), 2.14% for those with a platelet count of <142,000/µL or >417,000/µL, 1.11% for those with an NLR of >3.31, 1.69% for those with a PLR of >182.3, and 1.05% for those with an SII of >776.2. After accounting for potential confounding factors, we observed an association between PJI and an abnormal preoperative NLR (adjusted odds ratio [aOR]: 2.38, 95% confidence interval [CI]: 1.04 to 5.44, p = 0.039), PLR (aOR: 4.86, 95% CI: 2.15 to 10.95, p < 0.001), SII (aOR: 2.44, 95% CI: 1.09 to 5.44, p = 0.029), platelet count (aOR: 3.50, 95% CI: 1.11 to 10.99, p = 0.032), and hemoglobin level (aOR: 2.62, 95% CI: 1.06 to 6.50, p = 0.038). This study identified preoperative anemia, abnormal platelet count, and elevated NLR, PLR, and SII to be associated with an increased risk of PJI among patients with a body mass index of ≥40 kg/m 2 . These findings may help surgeons risk-stratify this high-risk patient population. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Regional Anaesthesia with Non Invasive Ventilation and Conscious Sedation: An Alternative to General Anaesthesia in Morbidly Obese Patients with Obstructive Sleep Apnea in Retrograde Intrarenal Surgery

Obstructive sleep apnea(OSA) is a syndrome characterized by obstruction in the upper airway during sleep. OSA patients undergoing procedures under GA are at increased risk for hypoxemia, pneumonia, difficult intubation, atelactasis, myocardial infarction making it a challenge for anesthesiologist. Retrograde intrarenal surgery(RIRS) is normally performed under GA to prevent respiratory embaracement. There are very few studies focusing on Regional anesthesia in RIRS procedure. A Sixty-three-year-old male known case of morbid obesity (BMI- 35 kg/meter square), OSA (on CPAP support at night) presented with left renal pelvis calculus, STOP BANG score (=5) therefore making it a case of difficult airway. Respiratory discomfort improved at 30-35-degree head up due to existing OSA considering the severe OSA and anticipated difficult airway, the surgery was planned under Lumbar subarachnoid block with preparation for management of difficult airway if conversion to GA required. 3 ml of 0.5 percent Bupivacaine heavy and 25 mcg fentanyl injected into subarachnoid space. T6 level block acheived after 3 minutes. The patient was put on his home CPAP machine with 5cm H2O PEEP. The patient was maintained on sponatneous ventilation and monitored using Etco2 at aliquot of 1mg midazolam given to mimic natural sleep pattern. The surgery was uneventful and the risk of induction of GA and difficult intubation was succesfully avoided. Patient with regional anaesthesia who are prone to converted to GA due to multiple risk factors, i.e., OSA with anticipated difficult airway can create a chaotic situation. So as a preliminary step NIV can be used, and along with it, mild sedation can be supplemented to improve acceptance and to avoid asynchrony. In this case NIV was used as a preemptive ventilation strategy even before actual requirement of BiPAP by mimicing the natural sleep pattern and make patient comfortable while a smooth conductance of the procedure.

Different Treatment Strategies in Reducing the Incidence of Major Post-Operative Pulmonary Complications in Morbidly Obese Patients Undergoing Bariatric Surgery

Different Treatment Strategies in Reducing the Incidence of Major Post-Operative Pulmonary Complications in Morbidly Obese Patients Undergoing Bariatric Surgery

Systematic Review of Outcomes of Total Hip Arthroplasty in Morbidly Obese Patients

Systematic Review of Outcomes of Total Hip Arthroplasty in Morbidly Obese Patients