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Anesthesia Principles I > Test 2 Obesity > Flashcards

Test 2 Obesity Flashcards

1
Q

what is the second leading cause of preventable death in the US?

A

obesity

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2
Q

__________% of US adults are classified as overweight or obese

A

75

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3
Q

BMI for “normal weight”

A

18.5-24.9

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4
Q

BMI for “overweight”

A

25-29.9

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5
Q

BMI for “obese”

A

30-34.9

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6
Q

BMI for “severely obese”/”obese 2”

A

35-39.9

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7
Q

BMI for “extreme obese”/”obese 3”

A

> /= 40

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8
Q

what is ideal body weight ?

A

normal/desirable weight

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9
Q

what is the formula for calculating IBW in men?

A

height (cm) - 100

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10
Q

IBW formula for women

A

height (cm) - 105

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11
Q

formula for lean body weight (LBW) =

A

IBW x 1.3

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12
Q

how do you calculate BMI?

A

weight (kg) / height (m^2)

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13
Q

_________________ is the measurement of height and body mass that exhibits the lowest morbidity and mortality for a given population

A

ideal body weight

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14
Q

android obesity

A

central abdominal obesity

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15
Q

waist circumference > _________ cm in men is characteristic for android obesity

A

102

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16
Q

waist circumfrence > ________ cm in women is characteristic for android obesity

A

88
35”

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17
Q

which type of obesity has a higher risk of comorbidities, difficult airway, and intubation ?

A

android

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18
Q

apple shape = ______________ obesity

A

android

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19
Q

pear shape = _____________________ obesity

A

gynecoid

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20
Q

which type of obesity will have an increased risk of varicose veins and joint disease

A

gynecoid

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21
Q

peripheral, gluteal femoral obesity is __________________ obesity

A

gynecoid

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22
Q

non-surgical management for obesity

A
  1. weight loss programs
  2. lifestyle changes
  3. behavioral modifications
  4. pharmacotherapy BMI > 30 kg/m2
  5. implanted gastric stimulators
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23
Q

in the management of obesity, ______________ options should be individualized to each patient based on the degree of obesity and co-existing dz

A

non-surgical

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24
Q

which non-surgical management technique is beneficial in the prevention of DM and CV events, and tx’s metabolic syndrome?

A

weight loss programs

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25
Q

pharmacotherapy options for management of obesity

A
  1. orlistat
  2. phentermine
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26
Q

_______________ is a lipase inhibitor that binds with dietary fats and is useful in the treatment of obesity

A

orlistat

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27
Q

_______________ is a sympathomimetic / appetite suppressant in the tx of obesity

A

phentermine

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28
Q

s/e with orlistat

A
  1. major GI side effects
  2. fat soluble vitamin deficiency
  3. coagulopathies due to vitamin K deficiency
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29
Q

s/e with phentermine

A
  1. palpitations
  2. tachycardia
  3. uncontrolled HTN
    4.tremor
  4. HA
  5. significant refractor hypotension with anesthesia
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30
Q

which medication for tx of obesity has no published guidelines related to anesthesia and discontinuation ?

A

phentermine

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31
Q

indication criteria for bariatric surgery?

A
  1. BMI > 40 kg/m2
  2. failed dietary therapy
  3. psychiatrically stable
  4. informed consent: procedure and sequelae
  5. motivated individual
  6. medical problems not precluding survival from surgery
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32
Q

what are the different types of bariatric surgery

A
  1. restrictive
  2. largely restrictive, mildly malabsorptive
  3. largely malabsorptive, mildly restrictive
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33
Q

what are the types of restrictive bariatric surgery

A
  1. lap adjustable gastric band
  2. lap sleeve gastrectomy
  3. vertical banded gastroplasty
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34
Q

lap adjustable gastric band

A
  1. reduces and limits food intake
  2. creates a small pouch from the proximal stomach to the GE jx
  3. allows for normal stomach emptying of liquids and slowed emptying of solid foods
  4. avoids permanent alteration of anatomy, has low mortality, and low re-operation rates.
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35
Q

lap sleeve gastrectomy

A
  1. permanently removes a portion of the stomach
  2. overeating can stretch sleeve thus negate the surgery
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36
Q

what are the risks with a lap sleeve gastrectomy

A
  1. infection
  2. staple line
  3. GERD
  4. malnutrition
  5. vomiting
  6. hypoglycemia
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37
Q

what are your largely restrictive, mildly malabsorptive bariatric surgeries

A

roux en y

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38
Q

what has become the procedure of choice for clinically severe obesity

A

Roux-en-Y

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39
Q

roux-en-y

A
  1. creation of small gastric pouch connected to the jejunum
  2. stapling or banding with roux-en-y anastomosis
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40
Q

risks with roux-en- y

A
  1. vitamin deficiency
  2. malnutrition
  3. ulcers
  4. perforation
  5. anemia
  6. staple line failure
  7. hernia
  8. dumping syndrome
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41
Q

what are the types of largely malabsorptive/mildly restrictive bariatric surgery

A
  1. biliopancreatic diversion
  2. duodenal switch
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42
Q

________________ is the gold standard in performing bariatric surgery

A

laparoscopy

43
Q

Periop management of OSA and OHS

A
  1. positive airway pressure
  2. regional or local over GA if can
  3. limited opioids, multimodal analgesia 4. use of short acting drugs
  4. postoperative monitoring in the PACU
44
Q

anesthetic implications with OSA

A
  1. increased sensitivity to anesthetic agents
  2. difficult airway
  3. increased post-op complications
  4. lg portion of surgical patients are undx
45
Q

STOP-BANG

A
  1. snoring
  2. tiredness
  3. observed apnea
  4. pressure (BP)
  5. BMI > 35
  6. Age > 50
  7. neck circ > 40 cm
  8. postoperative monitoring in the PACU
46
Q

obesity hyperventilation syndrome is aka ________________________

A

pickwickian syndrome

47
Q

what are the characteristics of obesity hyperventilation syndrome (OHS)

A
  1. OSA
  2. hypercapnia when awake (>45)
  3. daytime hypersomnolence <
  4. arterial hypoxia < 70
  5. polycythemia
  6. respiratory acidosis
  7. pulmonary HTN
  8. R-sided HF
48
Q

airway management with the obese patient

A
  1. ensure optimal pt positioning
  2. adequate pre-oxygenation (3-5 min 100%)
  3. careful administration with sedating drugs and of topical anesthesia
  4. airway plan A/B/C
  5. consider modified RSI
  6. have another set of skilled hands with you
49
Q

why is adequate preoxygenation essential in the obese patient?

A

rapid desaturation after loss of consciousness, increased O2 consumption, and decreased FRC

50
Q

respiratory considerations with obesity

A
  1. decreased chest wall and pulmonary compliance
  2. premature airway closing –> increased Vd, CO2 retention, V/Q mismatch, ad hypoxemia
  3. restrictive breathing pattern
  4. increased O2 consumption and CO2 production
  5. respiratory muscle dysfunction
  6. closely linked with asthma-like sx
51
Q

T/F: obesity predisposes the patient to respiratory failure

A

TRUE

52
Q

extreme obesity is associated with reductions in FRC, ERV, and TLC, what does this mean clinically for anesthesia?

A

they do not tolerate periods of apnea/hypoventilation; will desaturate quickly especially during induction

53
Q

OSA is associated with other co-morbiditeis

A

CAD
HTN
Ht. failure
CVA

54
Q

what is the definition of OSA

A

repetitive upper airway collapse leading to cessation of breathing during sleep lasting 10+ seconds

55
Q

what is the dx test for OSA

A

polysomnography

56
Q

the polysomnography for the dx of OSA determines the ______________, which is the?

A

apnea-hypopnea index; # of abnormal respiratory events/hr of sleep

57
Q

mild OSA = AHI of ___________

A

15-May

58
Q

moderate OSA = AHI of ______________

A

15-30

59
Q

severe OSA = AHI > ___________

A

30

60
Q

CV concerns with obesity

A
  1. increase CO and blood volume –> increased cardiac work load
  2. HTN
  3. hypercholesterolemia
  4. CAD <
  5. renal impairment
61
Q

what is an independent risk factor for obesity

A

CAD

62
Q

what is the primary cause of morbidity and mortality in obese pts

A

CV disease: IHD, HTN, cardiac failure

63
Q

CO increases by ___________ for each kg of fat acquired

A

0.1 L/min

64
Q

the increased cardiac workload from increased CO d/t obesity can lead to what?

A
  1. LVH
  2. cardiomegaly
  3. HTN
  4. eventual biventricular failure
65
Q

CAD is more common with what type of fat distrubtion

A

android (central)

66
Q

the cardiopulmonary sequelae ultimately results in _____________

A

biventricular failure

67
Q

blood pressure ahs been shown to increase __________ mmHg for every 10% increase in body weigh

A

6.5

68
Q

GI effects of obesity

A
  1. increased gastric residual volume/acidity
  2. GERD
  3. increased abdominal pressure
  4. hiatal hernia
  5. NASH - fatty liver dz
  6. cholelithiasis
  7. metabolic syndrome
69
Q

T/F: obesity is correlated with the incidence of subclinical hyperthyroidism in 25% of cases

A

false; hypothyroidism

70
Q

what is one of the most common surgeries performed in the obese patient?

A

laproscopic cholecysectomy

71
Q

if someone has metabolic syndrome (d/t obesity), this increases their risk for what?

A
  1. CV dz
  2. DM
  3. postoperative complications
72
Q

characteristics of metabolic syndrome

A
  1. abdominal/truncal obesity
  2. HTN
  3. insulin resistance
  4. dyslipidemia
73
Q

pts with _______________ type obesity are more correlated with the development of metabolic syndrome

A

android

74
Q

metabolic syndrome is more common in ______________ with obesity

A

men

75
Q

metabolic syndrome d/t obesity is correlated with other diseases/conditions?

A
  1. CV dz
  2. Polycystic ovarian syndrome
  3. fatty liver dz
  4. malignancy/cancer
  5. sexual dysfunction
  6. inflammation
  7. sleep disturbances
76
Q

what are the orthopedic implications of obesity

A
  1. OA d/t stress on weight bearing joints
  2. bone resorption and reduced bone density –> stress fracture risk
77
Q

which joints are commonly injured due to obesity

A

ankles, hips, knees, Lumbar spine

78
Q

during your preoperative evaluation of the obese pt, what drugs should you ask them if they are taking?

A
  1. wt loss drugs
  2. herbal supplements
  3. their daily meds
  4. Abx
  5. VTE prophylaxis
79
Q

what preoperative testing may be required for the obese patient?

A

those related to Cardiopulmonary, endocrine, GI/hepatic, and renal labs based on H&P and planned surgery

80
Q

due to the risk of CV dz and DM in the obese patient, what preoperative testing should be considered routine?

A

ECG

81
Q

the risk of _______________ after extubation is increased in obese patients

A

airway obstruction

82
Q

what position do CRNAs typically place an obese patient into prior to extubating

A

sitting / head up

83
Q

if there is doubt in the ability of an obese pt to maintain their airway if extubated, what can the CRNA do to evaluate?

A

extubate over an airway exchange catheter or via fiberoptic bronchoscope

84
Q

obese pt with R axis deviation/RBBB on ECG is suggestive of?

A

pulmonary htn and RVH

85
Q

obese pt with L BBB raises the concern of ________________

A

occult CAD

86
Q

why are dysrhythmias common in the obese pt?

A

fatty infiltration of the conduction system (SA/AV nodes)

87
Q

pts with a BMI > ______ will need increased dose of anticoagulants

A

50

88
Q

perianesthesia management of the obese pt

A
  1. planning is vital: suitable location, equipment, personnel
  2. IV access difficulty
  3. potential for difficult airway
  4. potential for GI aspiration: GI prophylaxis
  5. postoperative monitoring: SpO2, CPAP, ICU
89
Q

surgical position of the obese patient

A
  1. extra caution to prevent complications to prevent injury
  2. frequent assessment of pulses
  3. generous padding
  4. correct alignment + repeated inspection
  5. careful tx of the panniculus
90
Q

there is a high risk for _____________ and ____________ with obese patients in the OR, thus ensure the table can support the weight of the pt prior to surgery

A

falls; table failure

91
Q

what are the pharmacokinetic changes with obesity

A
  1. increased fat mass
  2. increased CO
  3. increased blood volume
  4. increased lean body weight
  5. changes in plasma protein binding
  6. reduced total body water
  7. increased renal clearance
  8. increased volume of lipid soluble drugs
  9. abnormal liver fx
  10. decreased pulmonary fx
92
Q

how do you give/dose water soluble drugs to the obese pt

A

according to IBW

93
Q

how do you give/dose lipid soluble drugs to the obese pt?

A

total body weight

94
Q

which inhalation agents have excellent recovery profiles in the obese pt?

A

des and sevo

95
Q

propofol administration implications for the obese pt

A
  1. induction dose on LBW
  2. maintenance dose on TBW
  3. cardiac depression at high doses in a concern
96
Q

T/F: fat mass does not affect the initial dose/redistribution of fat during induction

A

TRUE

97
Q

administration implications of succinycholine in the obese patient

A
  1. intubating dose based on TBW
  2. increased fluid compartment and pseudocholinesterase levels require higher doses to assure adequate paralysis
98
Q

administration implications of roc in the obese pt

A

all doses based on IBW

99
Q

administration implications of cisatracurium in the obese pt

A

all doses based on IBW

100
Q

administration implications of fentanyl/sufentanil in the obese pt

A
  1. loading dose based on TBW
  2. maintenance dose based on LBW & response
  3. increased distribution volume and elimination time correlate with the degree of obesity
101
Q

T/F: higher than usual infusion rates of precedex are recommended in the obese pt

A

false; lower than usual to minimize cardiac side effects

102
Q

rate of precedex in the obese pt

A

0.2 mcg/kg/min

103
Q

dosing of neostigmine in the obese pt is based on

A

TBW

104
Q

suggamadex in the obese pt is dosed based on ______________

A

TBW

Anesthesia Principles I (5 decks)

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