RESUMEN
OBJECTIVE: To identify the factors predicting morbidity and mortality in patients undergoing bariatric surgery for morbid obesity in our hospital. METHOD: Sixty bariatric surgery patients whose body mass indexes (BMI) exceeded 35 kg.m-2 were studied retrospectively. We examined the incidence of associated disease, the perioperative period, type of surgery, anesthetic technique, postoperative analgesia and the incidence of major complications. RESULTS: Fifty-one women and 9 men (mean age 43.33 +/- 10.25 years, mean BMI 46.41 +/- 6.04 kg/m-2) were studied. The incidences of high blood pressure (55%) and obstructive sleep apnea syndrome (40%) were high. Nine patients (15%) were physical status (ASA) I, 18 (30%) were ASA II, 27 (45%) were ASA III and 6 (10%) were ASA IV. Major complications developed in 3 cases (5%) in the first 24 h and in 8 (13.33%) in the first 7 days. The mortality rate was 0% among ASA I and II patients, 3.7% (1 death) among ASA III patients, and 33.33% (2 deaths) among ASA IV patients. All who died were men. The only factor that predicted morbidity in the first week after surgery was BMI. Both morbidity in the first 24 h and mortality were associated with greater underlying disease in our patients undergoing bariatric surgery. CONCLUSION: Major complications of bariatric surgery occurred in 18.3% of our patients and mortality was 5%. Physical status was a prognostic factor for both early (24 h) postoperative morbidity and mortality in our morbidly obese patients, whereas BMI was related to morbidity during the first week after surgery.
Asunto(s)
Anestesia/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Obesidad Mórbida/cirugía , Adulto , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad Mórbida/mortalidad , Complicaciones Posoperatorias/epidemiología , PronósticoRESUMEN
Objetivo: Determinar los factores pronósticos de morbimortalidad en pacientes intervenidos de cirugía bariátrica por obesidad mórbida en nuestro hospital. Método: Estudio retrospectivo de 60 pacientes con un índice de masa corporal (IMC) superior a 35 Kg-m-2 sometidos a cirugía bariátrica. Valoramos la incidencia de patología asociada, el período perioperatorio, el tipo de cirugía, la técnica anestésica, el tratamiento analgésico postoperatorio y la incidencia de complicaciones mayores. Resultados: Se estudiaron 51 mujeres y 9 varones, con una edad media de 43,33ñ10,25 años y un IMC de 46,41ñ6,04 Kg/m-2. La hipertensión arterial (HTA) y el síndrome de apnea del sueño (SAOS) presentaron una alta incidencia en nuestros pacientes, 55 por ciento y 40 por ciento respectivamente. En la clasificación del estado físico (ASA) de los pacientes, el 15 por ciento (9 pacientes) fueron ASA 1, 30 por ciento (18 pacientes) ASA 2, 45 por ciento (27 pacientes) ASA 3 y 10 por ciento (6 pacientes) ASA 4. Las complicaciones mayores en el período comprendido entre las primeras 24 horas ocurrieron en un 5 por ciento (3 casos) y en los primeros 7 días tuvieron una incidencia del 13,33 por ciento (8 casos). La mortalidad para los pacientes clasificados dentro del índice ASA 1 y ASA 2, fue del 0 por ciento, para los pacientes ASA 3 fue del 3,7 por ciento (1 caso), y del 33,33 por ciento en ASA 4 (2 casos). Todos los exitus ocurrieron en varones. El único factor pronóstico de morbilidad en la primera semana de postoperatorio fue el IMC. Tanto la morbilidad en las primeras 24 horas como la mortalidad postoperatoria en pacientes intervenidos de cirugía bariátrica está correlacionada con una mayor patología de base. Conclusión: Las complicaciones mayores en nuestra serie de cirugía bariátrica fue del 18,3 por ciento y la mortalidad fue del 5 por ciento. El índice ASA es un factor predictivo de morbilidad postoperatoria inmediata (24h) y mortalidad en pacientes con obesidad mórbida, en cambio, el IMC se correlaciona con la morbilidad durante la primera semana del postoperatorio. (AU)
Asunto(s)
Persona de Mediana Edad , Adulto , Anciano , Masculino , Femenino , Humanos , Procedimientos Quirúrgicos del Sistema Digestivo , Incidencia , Obesidad Mórbida , Complicaciones Posoperatorias , Pronóstico , AnestesiaRESUMEN
In our search to establish a reference .OH production system with respect to which the reactivity of copper(II) complexes could then be tested, the influence of free Cu2+ ions on the Cu+/H2O2 reaction has been investigated. This influence depends on the CCu2+/CCu+ ratio. At low Cu2+ concentrations, .OH damage to various detector molecules decreases with increasing Cu2+ concentrations until CCu2+/CCu+ reaches unity. Above this value, .OH damage increases sharply until CCu2+/CCu+ becomes equal to 5 with salicylate and 2 with deoxyribose, ratios for which the protective effect of Cu2+ cancels. Finally, at higher concentrations, Cu2+ ions logically add their own .OH production to that normally expected from Cu+ ions. The possible origin of this unprecedented alternate effect has been discussed. The possible influence of Cu+ ions on the generation of .OH radicals by water gamma radiolysis has also been tested and, as already established for Cu2+ in a previous work, shown to be nonexistent. This definitely confirms that either form of ionised copper cannot scavenge .OH radicals in the absence of a ligand.
Asunto(s)
Cobre , ADN/química , Radical Hidroxilo , Hierro , Cationes Bivalentes , Óxidos N-Cíclicos , Desoxirribosa/química , Espectroscopía de Resonancia por Spin del Electrón , Rayos gamma , Hidroxilación , Cinética , Salicilatos , Ácido Salicílico , Marcadores de SpinRESUMEN
Prior to comparative studies on the reactivity of various copper complexes with respect to OH. radicals, the influence of free Cu2+ ions on the superoxide-independent generation of OH. radicals through Fenton assays and water gamma radiolysis has been tested in the present work. Cu2+ ions have been shown to behave in a distinct manner towards each of these two production systems. As was logically expected from the noninvolvement of copper in OH. radical production through gamma radiolysis, no influence of Cu2+ ions has been observed on the amount of radicals detected in that case. In contrast, Cu2+ ions do influence OH. radical generation through iron-driven Fenton reactions, but differently depending on copper concentration. When present in high concentrations, Cu2+ ions significantly contribute to OH. radical production, which confirms previous observations on the reactivity of these in the presence of hydrogen peroxide. At lower levels corresponding to copper/iron ratios below unity on the contrary, Cu2+ ions behave as inhibitors of the OH. production in a pH-dependent manner over the 1-6 range investigated: the lower the pH, the greater the inhibition. The possible origin of this previously unreported inhibitory effect is discussed.