Obesity & Its Anesthetic Considerations

Question 1

What percent of the US population is overweight?

Answer 1

50

Question 2

What percent of the US population is obese?

Answer 2

22

Question 3

True or false: Obesity is the second most common cause of death in the US

Answer 3

True

Question 4

Define overweight, obese, and morbidly obese in terms of BMI

Answer 4

BMI > 24 = overweight
BMI 28-35 = obese
BMI > 40 = morbid obesity

Question 5

List some diseases linked to obesity

Answer 5

Diabetes
Coronary heart disease
High blood pressure
Stroke
GERD
Arthritis
Cancer
High cholesterol
Endocrine diseases

Question 6

What is the most common bariatric procedure in Australia and Europe?

Answer 6

Adjustable Gastric banding

Question 7

What is the most common bariatric procedure in the US?

Answer 7

Roux en Y

Question 8

What is metabolic syndrome?

Answer 8

The triad of obesity, Hypertension, And type II diabetes

Question 9

What effect does obesity have on cardiovascular pathophysiology?

Answer 9

It increases the metabolic demand therefore increasing the cardiac output

Question 10

For every 13.5 kg of fat gained What happens to the vascularization and cardiac output?

Answer 10

2.5 miles of neovascularization occurs

Increased cardiac output of 0.01 L/min for each kg of fat

Question 11

What should you assess in the cardiac evaluation of an obese patient?

Answer 11

History of prior MI
HTN
Angina
PVD

Question 12

Which lead looks at the largest amount of muscle mass for the left ventricle?

Answer 12

V5

Question 13

What is indicative of LVH on EKG?

Answer 13

Peaked R waves

Question 14

What is the difference in total body water percentage in the average adult versus the severely obese

Answer 14

The adult total body water percentage is 60 to 65%

Severely obese total body water is 40%

Question 15

How does the estimated blood volume it differ in an obese patient versus a nonobese

Answer 15

Estimated blood volume in an obese patient is 45 to 55 mL/kg actual bodyweight
70 mL/kg for the non-obese

Question 16

What effect does obesity have on respiratory pathophysiology

Answer 16

Increases CO2 production and oxygen consumption

Question 17

Obese people are more susceptible to what type of lung disease

Answer 17

Restrictive lung disease

Question 18

Why is pre-oxygenation so important in obese patients?

Answer 18

Because they have a decreased FRC

Question 19

FRC is composed of what

Answer 19

FRC = ERV + RV

Question 20

What is Pickwickian syndrome?

Answer 20

Obesity usually extreme
Hypercapnia
Polycythemia
Hypoxemia
Pulmonary hypertension
Somnolence
OSA

Question 21

What effects does obesity have G.I. pathophysiology?

Answer 21

Increased risk for aspiration

Increased incidence of GERD and hernias

Question 22

What are some pharmacological considerations for obese patients?

Answer 22

Increased volume of distribution
Increased GFR
Increased fat stores

Question 23

What are some anesthetic considerations for induction on an obese patient

Answer 23

Prepare for difficult intubation
Prepare for difficult mask ventilation
Induction may cause airway collapse
Increased risk for aspiration

Question 24

What is one way to help facilitate intubation on an obese patient

Answer 24

Ramping

Question 25

What do you always want to have in prior to extubation for an obese patient

Answer 25

Airway!

NAW or OAW

Question 26

What are the six D’s of a difficult airway?

Answer 26

1. Disproportion of tongue size
2. Distortion (neck mass)
3. Decreased thyromental distance
4. Decreased Mouth opening
5. Decreased motion of the C-spine
6. Dental overbite

Question 27

What is the best intraoperative position for obese patients

Answer 27

Reverse Trendelenburg

Question 28

What are two important considerations after extubation of an obese patient

Answer 28

Keep their head up and supply oxygen