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Aims: This prospective observational study evaluates the utility of non-invasive cardiac monitoring in obese patients in the day-surgery case, considering factors, such as Body Mass Index (BMI) and anaesthesia technique. Background: Obese patients are more likely to be admitted to hospital or to get hospitalized because they are more prone to concomitant diseases and obesity itself is not a contraindication to day surgery. Obese patients are a high-risk patient population that may particularly benefit from monitoring perioperative haemodynamic variations. Methods: In this observational study, we compared haemodynamic variations between overweight or obese and normal weight patients undergoing day-case surgery. We adopted NICOM® as a non-invasive cardiac output monitoring. Objective: The aim of the current study was to investigate the haemodynamic impact of BMI and anaesthesia technique during day-case surgery procedures. The other goal was to evaluate the feasibility and applications of non-invasive cardiac output monitoring among the obese population in day-surgery. Results: 74 patients were included in the study. 34 were overweight or obese (weight 84 ± 10 kg, height 160 ± 10 cm, BMI ≈ 30 kg/m2), 40 were normal weight (weight 63 ± 15 kg, height 160 ± 10 cm, BMI ≈ 22 kg/m2). Compared to normal-weight patients, obese patients show an increase in blood pressure with a return to baseline values at the end of surgery (p < 0.05). The Cardiac Output (CO) shows a similar trend, whereas the heart rate is normal. A decrease in the Cardiac Index (CI) during the operation was noticed in both groups, the one in obese patients (p = 0.24) being greater. In the same way, the Stroke Volume Index (SVI) was lower in obese patients during surgery (p < 0.05). In spinal anaesthesia, the Total Peripheral Resistance Index (TPRI) was not statistically different between the groups of study. As for the TPRI in obese patients, we reported values similar to the ones in non-obese patients in spinal anaesthesia. In local anesthesia, TPRI was higher in obese patients than in non-obese. Conclusion: Cardiovascular alterations in relation to obesity include an increase in blood pressure, CO and SV. An inadequate monitoring of haemodynamic parameters is a risk factor for perioperative complications. NICOM® provides a continuous, non-invasive haemodynamic measurement.

Post Surgical Pain (PSP) treatment represents a significant aspect of management of surgical patients. Incidence of severe PSP, with significant functional deficit is estimated at 5-10%. Most studies include a limited number of patients and this is a factor which affects power of results. Aims of our prospective observational study was to evaluate the incidence and characteristics of acute and chronic PSP in patients undergoing surgery at the university hospital of second university of naples.After Ethics Committee approval and written informed consent, the PSP acute on first day (at least 6 hours after surgery) through the International Pain Outcomes questionnaire was rated. Subsequently, patients were followed-up at 6 and 12 months; data collection took place by e-mail or phone and the Brief Pain Inventory and the DN4 were administered.We enrolled 235 patients, 219 performed the follow-up to 6months, 195 even that to 12 The incidence of CPSP at 6 months was of 45.2% for mild pain, 15.9% for moderate pain and of 2.7% for severe pain while the incidence of CPSP at 12 months was 35.9%, 11.8% and 2.5% respectively for the pain mild, moderate and severe. Neuropathic pain occurred in 40.3% of patients who CPSP moderate at 12 months compared with 31.9% of the patients interviewed at 6 months. Incidence and characteristics of PSP varied, often considerably, depending on the type of surgery, gender, age of the patient and the presence of PSP severe in the 24 hours following surgery.The incidence of CPSP 12 months after surgery must be improved in the next future. Preoperative pain and the percentage of time with severe pain during the first 24 hours after surgery seem to be CPSP predictors.Il trattamento del dolore postoperatorio (PSP) riveste un ruolo sempre più significativo nella gestione del paziente chirurgico. Esso ha un’incidenza media stimata del 30% con variazioni a seconda del tipo di intervento chirurgico. L’incidenza di PSP severo, con significativo deficit funzionale, è stimato al 5-10%. La maggior parte degli studi comprende un numero limitato di pazienti e ciò costituisce un fattore che ne pregiudica la validità. L’obiettivo principale del nostro studio osservazionale prospettico è stato quello di valutare l’incidenza e le caratteristiche del dolore postoperatorio (PSP) acuto e cronico in pazienti sottoposti ad interventi chirurgici presso l’Azienda Ospedaliera Universitaria della Seconda Università degli Studi di Napoli.Dopo approvazione del Comitato Etico e consenso informato scritto, è stato valutato il PSP acuto in prima giornata (ad almeno 6 ore dalla fine dell’intervento) tramite l’International Pain Outcomes questionnaire. Successivamente ci si è avvalsi del Brief Pain Inventory e del DN4 per il follow-up a 6 e 12 mesi avvenuto tramite e-mail o telefono.Sono stati arruolati 235 pazienti, 219 hanno eseguito il follow-up a 6 mesi, 195 anche quello a 12. L’incidenza di CPSP a 6 mesi è stata del 45,2 % per quanto riguarda il dolore lieve, del 15,9 % per il dolore moderato e dello 2,7 % per il dolore severo mentre l’incidenza di CPSP a 12 mesi è stata del 35,9% , 11,8% e 2,5% rispettivamente per il dolore lieve, moderato e severo. Evidenza di dolore neuropatico si è registrata nel 40,3% dei pazienti con CPSP moderato a 12 mesi contro il 31,9% dei pazienti intervistati a 6 mesi. L’incidenza e le caratteristiche del PSP variavano, spesso notevolmente, in base al tipo di chirurgia, al sesso, all’età del paziente e alla presenza di PSP severo nelle 24 ore successive all’intervento.Questo studio ha rivelato un’ incidenza rilevante di CPSP significativo 12 mesi dopo l’intervento chirurgico e tale risultato deve essere migliorato nel prossimo futuro. Il dolore preoperatorio e la percentuale di tempo con dolore severo durante le prime 24 ore dopo l’intervento sembrano essere fattori predittivi di CPSP.