Karen Mangarelli
20 statements · 1 topic
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there are some programs that require complete abstinence before they'll move forward with surgery. I, um, I'm not sure that that is the right way to go. Um, one, because, um, you know, ideally, we wanna be helping these patients before, um, surgery as well as through surgery and after surgery. And if we, um, have a hard stance that against, you know, any use whatsoever, um, I'm afraid that we'll be, you know, uh, Restricting surgery to patients who may need, really, really need it for medical reasons.
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Obesity
there was no real lower or minimum age limit, um, identified for, um, bariatric surgery, um, as well as they specifically talked about the Consideration of special populations, um, such as those with developmental disability, cognitive impairment on a case by case basis instead of previously where there was, uh, you know, an automatic exclusion
quote ·
Obesity
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Karen's statements about Obesity 20 statements
Preoperative Optimization and Management - Caren Mangarelli, MD - 2024 Pediatric Bariatric Surgery Update Course
Quotation
the first thing is screening for medical and behavioral health issues, um, as well as working those up, doing any sort of referrals as necessary, and providing support to the patient and family as needed. In addition to education regarding the procedures, the risks, benefits, as well as setting expectations for both the pre and post-operative time periods. Um, and then lastly, really lifestyle behavioral change support.
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Statement
The American Academy of Pediatrics section on obesity published technical report and policy statement in 2019 with less conservative bariatric surgery criteria more aligned with adult criteria.
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AAP 2019 selection criteria include BMI ≥40 or ≥140% of 95th percentile (whichever is lower), or BMI ≥35 or ≥120% of 95th percentile (whichever is lower) with a comorbid condition.
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Quotation
there was no real lower or minimum age limit, um, identified for, um, bariatric surgery, um, as well as they specifically talked about the Consideration of special populations, um, such as those with developmental disability, cognitive impairment on a case by case basis instead of previously where there was, uh, you know, an automatic exclusion
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Statement
The 2019 AAP guidelines removed minimum age limits for bariatric surgery and changed from automatic exclusion to case-by-case consideration for patients with developmental disability or cognitive impairment.
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Critical multidisciplinary team members are surgeon, medical specialist, behavioral/mental health specialist, and registered dietitian.
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Since December 2020, the FDA has approved three new medications for obesity treatment in patients 12 years and older, including two GLP-1 medications.
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The American Society of Anesthesiologists released consensus-based guidance recommending stopping daily GLP-1 medications on the day of procedure and weekly GLP-1 medications one week prior to procedure due to delayed gastric emptying and aspiration risk.
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Quotation
the GLP ones, one of the ways that they work for obesity is that they slow gastric emptying. And so, um, there has been a concern both, you know, practically and theoretically about, um, Regurgitation and therefore pulmonary aspiration of gastric contents
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The Teen Labs 5-year data showed micronutrient deficiencies do occur postoperatively, with iron being the most common deficiency both pre- and postoperatively, followed by vitamin D.
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The percentage of patients with micronutrient deficiencies increased over time postoperatively.
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In the past year, the program had several patients present postoperatively with B1 (thiamine) deficiency and one with folate deficiency, prompting reconsideration of preoperative screening protocols.
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My sense is that there will be more and more patients that come in to see us who will be using um marijuana.
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Quotation
there are some programs that require complete abstinence before they'll move forward with surgery. I, um, I'm not sure that that is the right way to go. Um, one, because, um, you know, ideally, we wanna be helping these patients before, um, surgery as well as through surgery and after surgery. And if we, um, have a hard stance that against, you know, any use whatsoever, um, I'm afraid that we'll be, you know, uh, Restricting surgery to patients who may need, really, really need it for medical reasons.
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Studies in adult populations up to 2 years have not shown that outcomes are different in patients who disclosed marijuana use.
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Quotation
the two pats, we have two patients who are actively seeing right now who've disclosed regular use, um, both of them, it has been, they're self-medicating their mental health, specifically anxiety.
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Teen Labs data shows alcohol use disorder is not uncommon postoperatively and requires ongoing screening and patient/family education about risk.
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Quotation
I do think it's important with pediatric patients that um you get them in the room alone, um, at some point just to make sure that this is what they want for themselves.
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One insurer has treated marijuana use similarly to nicotine smoking and requested ABG and pulmonary function tests.
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