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What is Pickwickian Syndrome?

Test your knowledge with the February 2018 Brain Teaser

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A: The Pickwickian syndrome, or obesity hypoventilation syndrome, occurs in overweight patients, typically during anesthesia. Patients cannot oxygenate properly because of fat reducing their respiratory function. Decreased lung capacity leads to a heavier workload on the heart, resulting in both cardiovascular and respiratory compromise. This leads to hypoxemia (low oxygen levels) and hypercapnia (increased CO2 levels). The solution is to assist with ventilation, manually or with a ventilator.

The term is borrowed from human medicine. The name originated from an overweight Charles Dickens character who suffered from respiratory difficulties.

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3 thoughts on “What is Pickwickian Syndrome?

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  2. Pickwichian was a character in Sir Authur Doyle, the doctor that wrote Sherlock Holms. He was a short man, without a obvious showing neck, in that his chin was near his chest. He had a barrel chest. From memory he had an enlarged right heart and likely tracheal disease. Doyle coined the phrase, ” Not invisible Watson, Just unnoticed. I cannot make you realize the importance of shirt sleeves, the suggestive of thumb nails and all the issues that hang from a boot lace”. from the papers of the Pickwichian Club. I studied this at Michigan State University, when Dr. George Eyster was teaching heart/chest radiology in the early 1980’s.

  3. Response to Answer: If need for anesthesia (Procedure to occur) would allow tilting the surgery table head up, hind end lower, this would reduce pressure on the diaphragm by internal organs and likely decrease ventilator inspiratory pressure required to maintain adequate gas exchanges ( ie less chance barotrauma).

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