Child, Preschool ; Humans ; Male ; Obesity Hypoventilation Syndrome ; diagnosis ; therapy

Obesity-Hypoventilation syndrome (OHS) is characterized by morbid obesity, hypoxia, and hypercapnea during wakefulness without parechymal lung disease or severe obstructive sleep apnea. A woman was admitted because of mental deterioration and diagnosed as OHS on the basis of obesity and hypoventilation, while awake, after ruling out other causes. By bilevel positive airway pressure (BiPAP) therapy, hypercapnea and hypoxia were resolved. We report that BiPAP can be an effective treatment for severe hypercapnea and hypoxia in OHS, which obviate the need for invasive endotracheal intubation.
Anoxia ; Female ; Humans ; Hypoventilation ; Intubation, Intratracheal ; Lung Diseases ; Obesity ; Obesity Hypoventilation Syndrome* ; Obesity, Morbid ; Sleep Apnea, Obstructive ; Wakefulness

The objective of this case report was to present a case of morbidly obese patient with Pickwikian syndrome for bariatric surgery, with specific emphasis on its clinical presentations and its anesthetic implications.
Human ; Male ; Adult ; OBESITY HYPOVENTILATION SYNDROME ; BARIATRIC SURGERY ; OBESITY, MORBID ; OBESITY ; ANESTHESIA

Obesity, with an increasing prevalence,has become one of the most common metabolic diseases. Obesity is associated with many respiratory diseases, especially sleep-related breathing disorders including obstructive sleep apnea-hypopnea syndrome, obesity hypoventilation syndrome, and overlap syndrome. This article reviews the association between obesity and these sleep-related breathing disorders.
Humans ; Obesity ; complications ; Obesity Hypoventilation Syndrome ; etiology ; Pulmonary Disease, Chronic Obstructive ; complications ; Sleep Apnea, Obstructive ; etiology

Adult ; Humans ; Male ; Obesity Hypoventilation Syndrome ; diagnosis ; therapy ; Polycythemia ; diagnosis ; therapy

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.
Airway Obstruction ; Anoxia ; Apnea ; Blood Gas Analysis ; Disorders of Excessive Somnolence ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Hypercapnia ; Hypertension, Pulmonary ; Hypoventilation ; Middle Aged ; Obesity Hypoventilation Syndrome* ; Obesity, Morbid ; Polysomnography ; Pulmonary Heart Disease ; Sleep Apnea, Obstructive ; Snoring

No abstract available.
Hirschsprung Disease* ; Hypoventilation*

Obesity, that is, having a body mass index (BMI) >30 kg/m2, has increased dramatically and became the most single most common preventable cause of death in South Korea. In the end, obesity results in metabolic syndrome, which includes abdominal obesity, increased triglycerides, decreased high-density lipoprotein, hypertension, and impaired glucose tolerance. Nonsurgical methods for obesity treatments include dietary therapy, exercise counseling, behavioral therapy, psychiatric therapy, and pharmacotherapy. Surgical methods for obesity treatments, laparoscopic gastric banding and Roux-en-Y gastric bypass, are commonly performed for obese patients, particularly those with a BMI of 40 kg/m2 or at BMI more than 30 kg/m2 with accompanying diseases related to metabolic syndrome such as hypertension, type 2 diabetes, hypercholesterolemia, asthma, angina, other cardiopulmonary diseases, infertility, polycystic ovary, urinary incontinence, severe arthritis, or Pickwickian syndrome. Preoperative evaluation for bariatric surgery should focus on airway management, sleep apnea history, use of a continuous positive airway pressure device, and comorbid systemic diseases. Special consideration and pharmacokinetic knowledge is needed for the choice and dose of the anesthetic agents as well as postoperative pain control, patient monitoring, fluid intake, and surgical complications. Obesity is a disease. Appropriate surgical intervention and peri-operative anesthetic care for bariatric surgery will increase the safety and satisfaction of obese patients and will finally provide a better quality of life for our society.
Airway Management ; Anesthesia ; Anesthetics ; Arthritis ; Asthma ; Bariatric Surgery ; Body Mass Index ; Cause of Death ; Continuous Positive Airway Pressure ; Counseling ; Exercise Therapy ; Female ; Gastric Bypass ; Glucose ; Humans ; Hypercholesterolemia ; Hypertension ; Infertility ; Lipoproteins ; Monitoring, Physiologic ; Obesity ; Obesity Hypoventilation Syndrome ; Obesity, Abdominal ; Ovary ; Pain, Postoperative ; Quality of Life ; Republic of Korea ; Sleep Apnea Syndromes ; Triglycerides ; Urinary Incontinence

BACKGROUND: There are many factors such as diffusion abnormality, V/Q mismatch, intrapulmonary shunt, alveolar hypoventilation and FIO2 in reducing arterial hypoxemia. Intrapulmonary shunting can be due to blood going from the right to the left side of the heart without respiring with alveolar gas(true shunt mechanism) or blood that respires but achieves a PaO2 less than the ideal (shunt effect mechanism). Understanding the portion of true shunt in patients with hypoxemia is very important indicator to analyze the effects of oxygen therapy. Several equations are used for calculation of physiologic shunt. The aim of this study was to calculate and compare shunts derived from four shunt equations; classic physiologic, estimated, modified clinical and simple equations. METHOD: After cardiovascular stability following open heart surgery, 40 patients were mechanically ventilated with an FIO2=1.0. Arterial and mixed blood gases were measured. We calculated and compared shunts by classic physiologic [S/T=(CcO2 CaO2)/(CcO2 CO2)], estimated [S/T=(CcO2 CaO2)/ (3.5 CcO2 CO2)], modified clinical [S/T= AaDO2 0.0031/(AaDO2 0.0031 CcO2 CaO2)], and simple equations [S/T=AaDO2/20]/ RESULTS: Shunts by classic physiologic, estimated, and modified clinical shunt equation were 26.9 8.5%, 25.1 7.1%, and 26.3 8.2%, respectively and did not differ one another significantly. Shunts by simple shunt equations was 18.8 6.2% and significantly lower than those by other 3 equations(P<0.05). CONCLUSIONS: It is reasonable to conclude that in post-open heart patients with stable cardiovascular function and mechanically ventilated with an FIO2=1.0, classic physiologic, estimated, and modified clinical shunt equations show a reliable reflection of the physiologic shunt. But simple equation (AaDO2/20) might be used as a simple estimate.
Anoxia ; Diffusion ; Gases ; Heart ; Humans ; Hypoventilation ; Oxygen ; Thoracic Surgery

BACKGROUND AND PURPOSE: Cerebrovascular reactivity (CVR) can be estimated by measuring the change of cerebral blood flow that occurs during vasostimulation. To estimate the cerebrovascular reactivity, we investigated the change of flow velocity of the internal carotid artery (ICA) and the middle cerebral artery (MCA) during hyperventilation and hypoventilation with the transcranial doppler. So we studied whether the CVR measured by this method could show a significant difference between the normal and the atherosclerotic subjects and whether the CVR may decrease with age in normal gubjects. METHODS: Using transcranial doppler, we measured the mean velocity (Vm), the pulsatility index (P.I.) at the resting state, the end of breath-holding and the end of hyperventilation in 30 normal and 10 atherosclerotic subjects, so we calculated the percentile change of mean velocity (% Vm) and P.I. (% P.I.) after the vasostimulation. We estimated the change of Vm, P.I., % Vm and % P.I. By the age group and compared those parameters between the age-matched normal control and atherosclerotic subjects. RESULTS: The Vm in ICA and MI significantly decreased with age (p<0.01), but there was no significant difference in Vm and P. I. Between normal and atherosclerotic subjects. The % Vm and % P.I. In response to hyperventilation significantly decreased with age in ICA, M1, M2 and there was significant difference in % Vm of ICA and M1 after breath-holding and % Vm of ICA after hyperventilation between the normal and atherosclerotic subjects. CONCLUSION: The breath-holding and hyperventilation tests could be non-invasive and useful methods in estimation of the cerebrovascular reactivity and could be applied in the basal and follow-up evaluation of the cerebrovascular reserve of the ischemic stroke patients.
Carotid Artery, Internal ; Humans ; Hyperventilation ; Hypoventilation ; Middle Cerebral Artery ; Stroke