pituitrin and Obesity--Morbid

Intraoperative oliguria is common during laparoscopic operations. The objective of this study was to evaluate the effects of prolonged pneumoperitoneum during laparoscopic gastric bypass (GBP) on intraoperative urine output and renal function.. 104 patients with a body mass index between 40 and 60 kg/m2 were randomly assigned to laparoscopic (n = 54) or open (n = 50) GBP. Intraoperative urine output was recorded at 30-min intervals. Blood urea nitrogen and creatinine levels were measured at baseline and on postoperative days 1, 2, and 3. Levels of antidiuretic hormone, aldosterone, and plasma renin activity were also measured in a subset of laparoscopic (n = 22) and open (n = 24) GBP patients at baseline, 2 hours after surgical incision, and in the recovery room.. The laparoscopic and open groups were similar in age, gender, and body mass index. There was no significant difference in amount of intraoperative fluid administered between groups (5.4 +/- 1.6 L, laparoscopic versus 5.8 +/- 1.7 L, open), but operative time was longer in the laparoscopic group (232 min versus 200 min, p < 0.01). Urinary output during laparoscopic GBP was 64% lower than during open GBP at 1 hour after surgical incision (19 mL versus 55 mL, p < 0.01) and continued to remain lower than that of the open group by 31-50% throughout the operation. Postoperative blood urea nitrogen and creatinine levels remained within the normal range in both groups. Serum levels of antidiuretic hormone, aldosterone, and plasma renin activity peaked at 2 hours after surgical incision with no significant difference between the two groups.. Prolonged pneumoperitoneum during laparoscopic gastric bypass significantly reduced intraoperative urine output but did not adversely alter postoperative renal function.

Topics: Adult; Aldosterone; Blood Urea Nitrogen; Creatinine; Female; Gastric Bypass; Humans; Intraoperative Period; Kidney; Laparoscopy; Male; Obesity, Morbid; Pneumoperitoneum, Artificial; Renin; Time Factors; Urine; Vasopressins

In this article, we present a clinical case of refractory septic shock resulting from intestinal perforation treated with high doses of vasopressin and hydrocortisone during emergency surgery. The use of such high doses of vasopressin for this type of shock is not described in the literature.. A 49-year-old white woman with grade III obesity, Crohn's disease, and an intestinal perforation presented with refractory septic shock. Initially, a low dose of vasopressin was used. Then, the dosage was increased to 0.4 U/minute; in the literature, this is defined as "salvage therapy." This therapy consists of an initial load followed by a continuous infusion of hydrocortisone.. The significant increase in her cardiac index and stroke volume index resulted in an improvement in peripheral resistance, gas exchange, and urine output and a decrease in her heart rate, interleukin-6 level, and tumor necrosis factor-α level. The administration of high doses of vasopressin and corticosteroids was demonstrated to be safe for the immune system, to reduce the systemic inflammatory response, and to have direct cardiovascular effects. Further studies are required to examine the use of vasopressin as an initial vasopressor as well as its use in high dosages and in combination with corticosteroids.

Topics: Acute Disease; Anti-Inflammatory Agents; Crohn Disease; Drug Therapy, Combination; Female; Humans; Hydrocortisone; Ileocecal Valve; Intestinal Perforation; Middle Aged; Obesity, Morbid; Shock, Septic; Tomography, X-Ray Computed; Vasoconstrictor Agents; Vasopressins

Quetiapine is an atypical antipsychotic with known α-adrenergic antagonism. We present a case of refractory hypotension that occurred after induction of general anesthesia in a patient being treated with quetiapine. This patient was not currently taking antihypertensives and had no known cardiovascular abnormalities. We observed that the hypotension was most responsive to vasopressin. We recommend further investigation regarding the interaction of quetiapine and general anesthesia.

Topics: Adult; Anesthesia, General; Antidepressive Agents, Second-Generation; Antimanic Agents; Antipsychotic Agents; Blood Pressure; Carbon Dioxide; Cardiac Surgical Procedures; Cyclohexanols; Dibenzothiazepines; Electronic Health Records; Ephedrine; Female; Humans; Hypotension; Intraoperative Complications; Lamotrigine; Obesity, Morbid; Operating Rooms; Oxygen; Phenylephrine; Quetiapine Fumarate; Triazines; Vasoconstrictor Agents; Vasopressins; Venlafaxine Hydrochloride

As endogenous opiates are known to be involved in regulation of appetite, an obese patient with panhypopituitarism and frequent episodes of ravenous hunger was treated with the oral opiate antagonist naltrexone for 13 months. This resulted in loss of body weight and attacks of severe hunger. The increased serum prolactin concentration and the dose of vasopressin required for substitution could be reduced. Long-term application of opiate antagonists may be useful in related cases.

Topics: Adult; Appetite; Drug Administration Schedule; Female; Humans; Hypopituitarism; Naltrexone; Obesity, Morbid; Prolactin; Vasopressins; Weight Loss