Anaesthetic considerations with the metabolic syndrome

British Journal of Anaesthesia

Volumn 105, Issue , 2010, Pages i24-i33

  Tung, A ^a  

^a UNIVERSITY OF CHICAGO   (United States)

Author keywords

anaesthesia; metabolic syndrome; obstructive sleep apnoea; preoperative evaluation

Indexed keywords

ANESTHESIA; CARDIOVASCULAR DISEASE; HUMAN; LUNG DISEASE; METABOLIC SYNDROME X; METHODOLOGY; PERIOPERATIVE PERIOD; REVIEW; RISK ASSESSMENT; RISK REDUCTION; SLEEP APNEA SYNDROME;

ANESTHESIA; CARDIOVASCULAR DISEASES; HUMANS; LUNG DISEASES; METABOLIC SYNDROME X; PERIOPERATIVE CARE; RISK ASSESSMENT; RISK REDUCTION BEHAVIOR; SLEEP APNEA, OBSTRUCTIVE;

EID: 79952196923     PISSN: 00070912     EISSN: 14716771     Source Type: Journal    
DOI: 10.1093/bja/aeq293     Document Type: Article

References (96)

1. Haller, H, Epidermiology and associated risk factors of hyperlipoproteinemia. Z Gesamte Inn Med 32 (1977), 124–128.
2. Pelosi, P, Gregoretti, C, Perioperative management of obese patients. Best Pract Res Clin Anaesthesiol 24 (2010), 211–225 doi:10.1016/j.bpa.2010.02.001.
3. Grundy, SM, Brewer, HB, Cleeman, JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association. Circulation 109 (2004), 433–438 doi:10.1161/01.CIR.0000111245.75752.C6.
4. Kahn, R, Buse, J, Ferrannini, E, Stern, M, The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 28 (2005), 2289–2304 doi:10.2337/diacare.28.9.2289.
5. Poulsen, P, Vaag, A, The impact of genes and pre- and postnatal environment on the metabolic syndrome. Evidence from twin studies. Panminerva Med. 45 (2003), 109–115.
6. Meas, T, Deghmoun, S, Chevenne, D, Gaborit, B, Alessi, MC, Lévy-Marchal, C, PAI-1 is an independent marker of metabolic disorders in young adults born SGA. J Thromb Haemost, 2010 (Epub ahead of print).
7. O'Rahilly, S, Spivey, RS, Holman, RR, Nugent, Z, Clark, A, Turner, RC, Type II diabetes of early onset: a distinct clinical and genetic syndrome?. Br Med J (Clin Res Ed) 294 (1987), 923–928 doi:10.1136/bmj.294.6577.923.
8. Considine, RV, Sinha, MK, Heiman, ML, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med 334 (1996), 292–295 doi:10.1056/NEJM199602013340503.
9. Bik, W, Ostrowski, J, Baranowska-Bik, A, et al. Adipokines and genetic factors in overweight or obese but metabolically healthy Polish women. Neuro Endocrinol Lett, 31, 2010 (Epub ahead of print).
10. Bajnok, L, Seres, I, Varga, Z, et al. Relationship of serum resistin level to traits of metabolic syndrome and serum paraoxonase 1 activity in a population with a broad range of body mass index. Exp Clin Endocrinol Diabetes 116 (2008), 592–599 doi:10.1055/s-2008-1065350.
11. Guize, L, Thomas, F, Pannier, B, Bean, K, Jego, B, Benetos, A, All-cause mortality associated with specific combinations of the metabolic syndrome according to recent definitions. Diabetes Care 30 (2007), 2381–2387 doi:10.2337/dc07-0186.
12. Moebus, S, Balijepalli, C, Lösch, C, et al. Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome—a cross-sectional study. Cardiovasc Diabetol 9 (2010), 34–46 doi:10.1186/1475-2840-9-34.
13. National Health and Nutrition Examination Survey Homepage. Available from www.cdc.gov/nchs/nhanes.htm (accessed September 5, 2010).
14. Ford, ES, Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. Diabetes Care 28 (2005), 2745–2749 doi:10.2337/diacare.28.11.2745.
15. Echahidi, N, Mohty, D, Pibarot, P, et al. Obesity and metabolic syndrome are independent risk factors for atrial fibrillation after coronary artery bypass graft surgery. Circulation 116 (2007), I213–I219.
16. Vijayaraghavan, K, Jeffries, ML, Windsor, ML, et al. Metabolic syndrome and postoperative complications in cardiothoracic and vascular surgical and percutaneous interventions. J Am Osteopath Assoc, 105, 2005, 27.
17. Shen, Z, Wang, S, Ye, Y, et al. Clinical study on the correlation between metabolic syndrome and colorectal carcinoma. ANZ J Surg 80 (2010), 331–336 doi:10.1111/j.1445-2197.2009.05084.x.
18. Pelucchi, C, Negri, E, Talamini, R, et al. Metabolic syndrome is associated with colorectal cancer in men. Eur J Cancer 46 (2010), 1866–1872 doi:10.1016/j.ejca.2010.03.010.
19. Grundmark, B, Garmo, H, Loda, M, Busch, C, Holmberg, L, Zethelius, B, The metabolic syndrome and the risk of prostate cancer under competing risks of death from other causes. Cancer Epidemiol Biomarkers Prev 19 (2010), 2088–2096 doi:10.1158/1055-9965.EPI-10-0112.
20. Bjørge, T, Stocks, T, Lukanova, A, et al. Metabolic syndrome and endometrial carcinoma. Am J Epidemiol 171 (2010), 892–902 doi:10.1093/aje/kwq006.
21. Häggström, C, Stocks, T, Rapp, K, et al. Metabolic syndrome and risk of bladder cancer: prospective cohort study in the metabolic syndrome and cancer project (Me-Can). Int J Cancer, 2010 (Epub ahead of print).
22. Bjørge, T, Lukanova, A, Jonsson, H, et al. Metabolic syndrome and breast cancer in the me-can (metabolic syndrome and cancer) project. Cancer Epidemiol Biomarkers Prev 19 (2010), 1737–1745 doi:10.1158/1055-9965.EPI-10-0230.
23. Lohsiriwat, V, Pongsanguansuk, W, Lertakyamanee, N, Lohsiriwat, D, Impact of metabolic syndrome on the short-term outcomes of colorectal cancer surgery. Dis Colon Rectum 53 (2010), 186–191.
24. Gandhi, R, Razak, F, Davey, JR, Mahomed, NN, Metabolic syndrome and the functional outcomes of hip and knee arthroplasty. J Rheumatol 37 (2010), 1917–1922 doi:10.3899/jrheum.091242.
25. Mullen, JT, Moorman, DW, Davenport, DL, The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250 (2009), 166–172 doi:10.1097/SLA.0b013e3181ad8935.
26. Echahidi, N, Pibarot, P, Després, JP, et al. Metabolic syndrome increases operative mortality in patients undergoing coronary artery bypass grafting surgery. J Am Coll Cardiol 50 (2007), 843–851 doi:10.1016/j.jacc.2007.04.075.
27. Yilmaz, MB, Guray, U, Guray, Y, et al. Metabolic syndrome negatively impacts early patency of saphenous vein grafts. Coron Artery Dis 17 (2006), 41–44 doi:10.1097/00019501-200602000-00007.
28. Kajimoto, K, Kasai, T, Miyauchi, K, et al. Metabolic syndrome predicts 10-year mortality in non-diabetic patients following coronary artery bypass surgery. Circ J 72 (2008), 1481–1486 doi:10.1253/circj.CJ-07-0928.
29. Glance, LG, Wissler, R, Mukamel, DB, et al. Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 113 (2010), 859–872.
30. Protack, CD, Bakken, AM, Xu, J, Saad, WA, Lumsden, AB, Davies, MG, Metabolic syndrome: a predictor of adverse outcomes after carotid revascularization. J Vasc Surg 49 (2009), 1172–1180 doi:10.1016/j.jvs.2008.12.011.
31. Tefekli, A, Kurtoglu, H, Tepeler, K, et al. Does the metabolic syndrome or its components affect the outcome of percutaneous nephrolithotomy?. J Endourol 22 (2008), 35–40 doi:10.1016/j.jvs.2008.12.011.
32. Girerd, N, Pibarot, P, Fournier, D, et al. Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery. Eur Heart J 30 (2009), 1270–1278 doi:10.1093/eurheartj/ehp091.
33. Hudetz, JA, Patterson, KM, Iqbal, Z, Gandhi, SD, Pagel, PS, Metabolic syndrome exacerbates short-term postoperative cognitive dysfunction in patients undergoing cardiac surgery: results of a pilot study. J Cardiothorac Vasc Anesth, 2010 (Epub ahead of print).
34. McGirt, MJ, Woodworth, GF, Ali, M, Than, KD, Tamargo, RJ, Clatterbuck, RE, Persistent perioperative hyperglycemia as an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 107 (2007), 1080–1085 doi:10.3171/JNS-07/12/1080.
35. Furnary, AP, Zerr, KJ, Grunkemeier, GL, Starr, A, Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 67 (1999), 352–360 doi:10.3171/JNS-07/12/1080.
36. Kao, LS, Meeks, D, Moyer, VA, Lally, KP, Peri-operative glycaemic control regimens for preventing surgical site infections in adults. Cochrane Database Syst Rev, 2009, CD006806.
37. Moitra, VK, Greenberg, J, Arunajadai, S, Sweitzer, B, The relationship between glycosylated hemoglobin and perioperative glucose control in patients with diabetes. Can J Anaesth 57 (2010), 322–329 doi:10.1007/s12630-010-9266-8.
38. O'Sullivan, CJ, Hynes, N, Mahendran, B, et al. Haemoglobin A1c (HbA1C) in non-diabetic and diabetic vascular patients. Is HbA1C an independent risk factor and predictor of adverse outcome?. Eur J Vasc Endovasc Surg 32 (2006), 188–197.
39. Acott, AA, Theus, SA, Kim, LT, Long-term glucose control and risk of perioperative complications. Am J Surg 198 (2009), 596–599 doi:10.1016/j.amjsurg.2009.07.015.
40. Furnary, AP, Gao, G, Grunkemeier, GL, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 125 (2003), 1007–1021 doi:10.1067/mtc.2003.181.
41. Chaney, MA, Nikolov, MP, Blakeman, BP, Bakhos, M, Attempting to maintain normoglycemia during cardiopulmonary bypass with insulin may initiate postoperative hypoglycemia. Anesth Analg 89 (1999), 1091–1095.
42. Coughlin, SR, Mawdsley, L, Mugarza, JA, Calverley, PM, Wilding, JP, Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 25 (2004), 735–741 doi:10.1016/j.ehj.2004.02.021.
43. Lam, JC, Lam, B, Lam, CL, et al. Obstructive sleep apnoea and the metabolic syndrome in community-based Chinese adults in Hong Kong. Respir Med 100 (2006), 980–987 doi:10.1016/j.rmed.2005.10.003.
44. McArdle, N, Hillman, D, Beilin, L, Watts, G, Metabolic risk factors for vascular disease in obstructive sleep apnoea. Am J Respir Crit Care Med 175 (2007), 190–195 doi:10.1164/rccm.200602-270OC.
45. Kono, M, Tatsumi, K, Saibara, T, et al. Obstructive sleep apnoea syndrome is associated with some components of metabolic syndrome. Chest 131 (2007), 1387–1392.
46. Vgontzas, AN, Bixler, EO, Chroussos, GP, Sleep apnoea is a manifestation of the metabolic syndrome. Sleep Med Rev 9 (2005), 211–224 doi:10.1016/j.smrv.2005.01.006.
47. Gross, JB, Bachenberg, KL, Benumof, JL, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnoea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnoea. Anesthesiology 104 (2006), 1081–1093 doi:10.1097/00000542-200605000-00026.
48. Sabers, C, Plevak, DJ, Schroeder, DR, Warner, DO, The diagnosis of obstructive sleep apnoea as a risk factor for unanticipated admissions in outpatient surgery. Anesth Analg 96 (2003), 1328–1335 doi:10.1213/01.ANE.0000061585.09157.66.
49. Hwang, D, Shakir, N, Limann, B, et al. Association of sleep-disordered breathing with postoperative complications. Chest 133 (2008), 1128–1134 doi:10.1378/chest.07-1488.
50. Liao, P, Yegneswaran, B, Vairavanathan, S, Zilberman, P, Chung, F, Postoperative complications in patients with obstructive sleep apnoea: a retrospective matched cohort study. Can J Anaesth 56 (2009), 819–828 doi:10.1007/s12630-009-9190-y.
51. Mickelson, SA, Preoperative and postoperative management of obstructive sleep apnoea patients. Otolaryngol Clin North Am 40 (2007), 877–889 doi:10.1016/j.otc.2007.04.007.
52. Tung, A, Herrera, S, Szafran, MJ, Kasza, K, Mendelson, WB, Effect of sleep deprivation on righting reflex in the rat is partially reversed by administration of adenosine A1 and A2 receptor antagonists. Anesthesiology 102 (2005), 1158–1164 doi:10.1097/00000542-200506000-00015.
53. Chung, F, Ward, B, Ho, J, Yuan, H, Kayumov, L, Shapiro, C, Preoperative identification of sleep apnoea risk in elective surgical patients, using the Berlin questionnaire. J Clin Anesth 19 (2007), 130–134 doi:10.1016/j.jclinane.2006.08.006.
54. Chung, F, Yegneswaran, B, Liao, P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnoea. Anesthesiology 108 (2008), 812–821 doi:10.1097/ALN.0b013e31816d83e4.
55. Kryger, MH, Diagnosis and management of sleep apnoea syndrome. Clin Cornerstone 2 (2000), 39–47 doi:10.1016/S1098-3597(00)90039-5.
56. Gali, B, Whalen, FX, Schroeder, DR, Gay, PC, Plevak, DJ, Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnoea screening tool and postanaesthesia care assessment. Anesthesiology 110 (2009), 869–877 doi:10.1097/ALN.0b013e31819b5d70.
57. Sundaram, S, Bridgman, SA, Lim, J, Lasserson, TJ, Surgery for obstructive sleep apnoea. Cochrane Database Syst Rev, 2005, CD001004.
58. Collop, NA, Block, AJ, Hellard, D, The effect of nightly nasal CPAP treatment on underlying obstructive sleep apnoea and pharyngeal size. Chest 99 (1991), 855–860 doi:10.1378/chest.99.4.855.
59. Jaimchariyatam, N, Rodriguez, CL, Budur, K, Does CPAP treatment in mild obstructive sleep apnoea affect blood pressure?. Sleep Med 11 (2010), 837–842.
60. Terris, DJ, Fincher, EF, Hanasono, MM, Fee, WE Jr, Adachi, K, Conservation of resources: indications for intensive care monitoring after upper airway surgery on patients with obstructive sleep apnoea. Laryngoscope 108 (1998), 784–788 doi:10.1097/00005537-199806000-00002.
61. Jensen, C, Tejirian, T, Lewis, C, Yadegar, J, Dutson, E, Mehran, A, Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4 (2008), 512–514 doi:10.1016/j.soard.2008.05.003.
62. Chang, LC, Huang, KC, Wu, YW, et al. The clinical implications of blood adiponectin in cardiometabolic disorders. J Formos Med Assoc 108 (2009), 353–366 doi:10.1016/S0929-6646(09)60079-6.
63. Wong, ND, Sciammarella, MG, Polk, D, et al. The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium. J Am Coll Cardiol 41 (2003), 1547–1553 doi:10.1016/S0735-1097(03)00193-1.
64. Konstantinou, DM, Chatzizisis, YS, Louridas, GE, Giannoglou, GD, Metabolic syndrome and angiographic coronary artery disease prevalence in association with the Framingham risk score. Metab Syndr Relat Disord 8 (2010), 201–208 doi:10.1089/met.2009.0059.
65. Bayturan, O, Tuzcu, EM, Lavoie, A, et al. The metabolic syndrome, its component risk factors, and progression of coronary atherosclerosis. Arch Intern Med 170 (2010), 478–484 doi:10.1001/archinternmed.2009.551.
66. Li, C, Ford, ES, McGuire, LC, Mokdad, AH, Association of metabolic syndrome and insulin resistance with congestive heart failure: findings from the Third National Health and Nutrition Examination Survey. J Epidemiol Community Health 61 (2007), 67–73 doi:10.1136/jech.2006.048173.
67. Fleisher, LA, Beckman, JA, Brown, KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 116 (2007), 418–499 doi:10.1161/CIRCULATIONAHA.107.185699.
68. McFalls, EO, Ward, HB, Moritz, TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 351 (2004), 2795–2804 doi:10.1056/NEJMoa041905.
69. Oscarsson, A, Gupta, A, Fredrikson, M, et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth 104 (2010), 305–312 doi:10.1093/bja/aeq003.
70. Horlocker, TT, Wedel, DJ, Rowlingson, JC, et al. Regional anaesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anaesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 35 (2010), 64–101 doi:10.1097/AAP.0b013e3181c15c70.
71. Ouattara, A, Benhaoua, H, Le Manach, Y, et al. Perioperative statin therapy is associated with a significant and dose-dependent reduction of adverse cardiovascular outcomes after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 23 (2009), 633–638 doi:10.1053/j.jvca.2009.02.008.
72. Borghi, C, Cicero, AF, Ambrosioni, E, Effects of early treatment with zofenopril in patients with myocardial infarction and metabolic syndrome: the SMILE Study. Vasc Health Risk Manag 4 (2008), 665–671.
73. Brabant, SM, Bertrand, M, Eyraud, D, Darmon, PL, Coriat, P, The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg 89 (1999), 1388–1392 doi:10.1097/00000539-199912000-00011.
74. Lindenauer, PK, Pekow, P, Wang, K, Mamidi, DK, Gutierrez, B, Benjamin, EM, Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 353 (2005), 349–361 doi:10.1056/NEJMoa041895.
75. Hoeks, SE, Scholte Op Reimer, WJ, van Urk, H, et al. Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg 33 (2007), 13–19 doi:10.1016/j.ejvs.2006.06.019.
76. Schouten, O, Hoeks, SE, Welten, GM, et al. Effect of statin withdrawal on frequency of cardiac events after vascular surgery. Am J Cardiol 100 (2007), 316–320 doi:10.1016/j.amjcard.2007.02.093.
77. Lee, EJ, In, KH, Ha, ES, et al. Asthma-like symptoms are increased in the metabolic syndrome. J Asthma 46 (2009), 339–342 doi:10.1080/02770900802660931.
78. Lindström, D, Sadr Azodi, O, Wladis, A, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg 248 (2008), 739–745 doi:10.1097/SLA.0b013e3181889d0d.
79. Thomas, JA, McIntosh, JM, Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Phys Ther 74 (1994), 3–10.
80. Neligan, PJ, Metabolic syndrome: anaesthesia for morbid obesity. Curr Opin Anesthesiol 23 (2010), 375–383 doi:10.1097/ACO.0b013e328338caa0.
81. Liu, SS, Wu, CL, The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systematic review. Anesth Analg 105 (2007), 789–808 doi:10.1213/01.ane.0000278089.16848.1e.
82. Ageno, W, Prandoni, P, Romualdi, E, et al. The metabolic syndrome and the risk of venous thrombosis: a case–control study. J Thromb Haemost 4 (2006), 1914–1918 doi:10.1111/j.1538-7836.2006.02132.x.
83. Gandhi, R, Razak, F, Tso, P, Davey, JR, Mahomed, NN, Metabolic syndrome and the incidence of symptomatic deep vein thrombosis following total knee arthroplasty. J Rheumatol 36 (2009), 2298–2301 doi:10.3899/jrheum.090282.
84. Steffen, LM, Cushman, M, Peacock, JM, et al. Metabolic syndrome and risk of venous thromboembolism: Longitudinal Investigation of Thromboembolism Etiology. J Thromb Haemost 7 (2009), 746–751 doi:10.1111/j.1538-7836.2009.03295.x.
85. Prystowsky, JB, Morasch, MD, Eskandari, MK, Hungness, ES, Nagle, AP, Prospective analysis of the incidence of deep venous thrombosis in bariatric surgery patients. Surgery 138 (2005), 759–765 doi:10.1016/j.surg.2005.07.024.
86. Liem, TK, Huynh, TM, Moseley, SE, et al. Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis. J Vasc Surg 52 (2010), 651–657.
87. Kearon, C, Hirsh, J, Management of anticoagulation before and after elective surgery. N Engl J Med 336 (1997), 1506–1511 doi:10.1056/NEJM199705223362107.
88. Sapala, JA, Wood, MH, Schuhknecht, MP, Sapapa, MA, Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 13 (2003), 819–825 doi:10.1381/096089203322618588.
89. Obeid, FN, Bowling, WM, Fike, JS, Durant, JA, Efficacy of prophylactic inferior vena cava filter placement in bariatric surgery. Surg Obes Rel Dis 3 (2007), 606–610 doi:10.1016/j.soard.2007.08.005.
90. Cotter, AS, Cantrell, W, Fisher, B, Shopnick, R, Efficacy of venous thromboembolism prophylaxis in morbidly obese patients undergoing gastric bypass surgery. Obes Surg 15 (2005), 1316–1320 doi:10.1381/096089205774512690.
91. Roderick, P, Ferris, G, Wilson, K, et al. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol Assess 9 (2005), 1–78.
92. Huo, MH, Salvati, EA, Sharrock, NE, et al. Intraoperative adjusted-dose heparin thromboembolic prophylaxis in primary total hip arthroplasty. Clin Orthop Relat Res 277 (1992), 188–196.
93. Westrich, GH, Menezes, A, Sharrock, N, Sculco, TP, Thromboembolic disease prophylaxis in total knee arthroplasty using intraoperative heparin and postoperative pneumatic foot compression. J Arthroplasty 14 (1999), 651–656 doi:10.1016/S0883-5403(99)90217-6.
94. Agnelli, G, Becattini, C, Acute pulmonary embolism. N Engl J Med 363 (2010), 266–274 doi:10.1056/NEJMra0907731.
95. Stone, P, Burnett, A, Burton, B, Roman, J, Overcoming extreme obesity with robotic surgery. Int J Med Robot, 2010 (Epub ahead of print).
96. Lee, WJ, Huang, MT, Wang, W, Lin, CM, Chen, TC, Lai, IR, Effects of obesity surgery on the metabolic syndrome. Arch Surg 139 (2004), 1088–1092 doi:10.1001/archsurg.139.10.1088.