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What Every Anaesthetist Needs to Know About Respiratory and Cardiovascular Dynamics in Patients with Obesity or Intra-abdominal Hypertension

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Anesthesia in High-Risk Patients

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Abstract

The incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) is still underappreciated by clinicians working in the emergency department (ED), operating room (OR) or intensive care unit (ICU), around the world. Of note, one in four patients will have signs and symptoms of IAH on admission, whilst one out of two will develop IAH within the first week of ICU stay. Moreover, 1 in 20 patients will develop overt ACS, a lethal syndrome with a mortality rate above 75% when left untreated. Still, every day, patients may be exposed to the risks of unrecognised pathological increases in intra-abdominal pressure (IAP). Every ED, OR and ICU physician should therefore understand the pathophysiological mechanisms that may impact end-organ function when IAP is increased. IAP measurement is a first step, followed by prevention and medical measurements to lower the IAP. Monitoring of the respiratory and cardiovascular function during anaesthesia and surgery is of great importance. This chapter will focus on the definitions, how to measure IAP, and how to deal with the respiratory and cardiovascular derangements listing some simple tips that can be used at the bedside.

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Acknowledgements

Dr. Manu Malbrain is a member of the Executive Committee of the Abdominal Compartment Society, formerly known as the World Society of the Abdominal Compartment Syndrome (https://www.wsacs.org/). He is the founding president of WSACS and current treasurer; he is also a member of the medical advisory Board of Pulsion Medical Systems (part of Maquet Getinge Group) and consults for ConvaTec, Acelity, Spiegelberg and Holtech Medical. He is the co-founder of the International Fluid Academy (IFA). The IFA is integrated within the not-for-profit charitable organisation iMERiT, International Medical Education and Research Initiative, under the Belgian law. The IFA website (http://www.fluidacademy.org) is now an official SMACC (Social Media and Critical Care)-affiliated site, and its content is based on the philosophy of FOAM (Free Open Access Medical education—#FOAMed). Parts of this chapter contribute to the proceedings of the 8th World Congress of the Abdominal Compartment Society (WCACS, www.wcacs2017.org), Banff, Alberta, Canada (June 15–17, 2017), presented at the meeting and published under the Open Access CC BY Licence in Anaesthesiology and Intensive Therapy [66].

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Authors and Affiliations

  1. Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Lange Beeldekensstraat 267, B-2060, Antwerpen, Belgium

    Manu LNG Malbrain M.D., Ph.D.

  2. ICU Director, University Hospital Brussels (UZB), Jette, Belgium and Professor at Vrije Universiteit Brussel (VUB), Faculty of Medicine, Brussels, Belgium

    Manu LNG Malbrain M.D., Ph.D.

  3. The American British Cowdray Medical Center, Universidad Anahuac, Mexico City, Mexico

    Claudia Olvera M.D.

  4. Intensive Care Unit, Fiona Stanley Hospital, Murdoch Drive, Murdoch, 6152, WA, Australia

    Adrian Regli M.D

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  1. Manu LNG Malbrain M.D., Ph.D.
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Correspondence to Manu LNG Malbrain M.D., Ph.D. .

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  1. Department of Anaesthesiology and Critical Care Medicine, Louis Pradel Hosp, Hospices Civils Lyon, Lyon, Rhône, France

    Jean-Luc Fellahi

  2. Service d'Anesthésie-Réanimation, Hôpital Nord, Marseille cedex 20, France

    Marc Leone

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Malbrain, M.L., Olvera, C., Regli, A. (2018). What Every Anaesthetist Needs to Know About Respiratory and Cardiovascular Dynamics in Patients with Obesity or Intra-abdominal Hypertension. In: Fellahi, JL., Leone, M. (eds) Anesthesia in High-Risk Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60804-4_7

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