Obesity SG 10-18 Flashcards
To master the care and anesthesia for the the hot and fluffy hippo hopper population
When should an obese pt be extubated (what are you going to assess for)
- Hemodynamically stable
- Able to be placed in a heads up or sitting position
- Muscle relaxant adequatly reversed (and verifed with twitch monitor
- Awake and alert
- Sustain head lift x 5 seconds
- Effective cough
What are the following respiratory values for extubation of the obese pt Respiratory Rate- Neg inspiratory Force- Vital Capacity- Tidal Volume-
Respiratory Rate- < 30 bpm
Neg inspiratory Force- -25 to -30 cmH2O
Vital Capacity- 10-15 ml/kg
Tidal Volume- 5ml/kg (of IBW)
What is included in the post-operative management of the obese pt? ( Basically what are you going to do to the pt when you drop them off in PACU)
- Semi upright position (45 degree if poss)
- Nasal Airway
- O2 sat monitoring
- O2 if needed
- CPAP if OSA hx
- Carefull admin of pain meds
- Lung recrutment tech (IS)
What may be a complication in obese pt’s especially with bariatric pt’s with BMI > 40, from laying in one position too long?
Rhabdomyolysis (and renal failure)
How is the CV system impacted by obesity?
- Systemic HTN
- CAD
- Left and/or Right sided HF
- Increased metabolic demend
- Increased CO
- Increased SV
- Increased circulating blood volume
Just to tie it all together**all this leads to LVH and pump failure due to the chronically high SVR with decreased coronary artery perfusion, and when demand is not met our friend MI makes a little visit*
How is the respiratory system impacted by obesity?
- frequently (do not think always or automatic) difficult airway dur to excessive pharyngeal tissue (AKA redundant tissue)
- OSA
- OHS
- Orthopnea
- Decreased FRC
- Increasd O2 comsumption
- Increased CO2 production
B/c the obese pt has a decreased FRC what may often occur upon induction? and extubation?
Induction: rapid decline of SPO2
extubation: increased anxiety (if waking supine)
How is the GI system impacted by obesity?
- Increased gastric emptying
- Increased IAP
- Increased risk of GERD
- Increased risk of pulmonary aspiration
How is the Liver impacted by obesity?
- Abnorma LFTs
- Fatty liver disease (hepatitis)
- Increased fat stores for VAA
Alterations in volume of distribution are r/t what in the obesity pt?
- Size of fat organ
- Increased blood volume
- Increased CO
- Decreased body water
- Alterations in protein binding
- alterations in lipophilicity of the drug
Highly lipophillic (hydrophobic) drugs have a _______ volume of distribution in obese pt’s leading to a need for ____________ drug doses.
-high
- Increased
a litle example.
That being said.. larger fat stores provide and increased VD for lipid soluable drugs such as narcotics and Benzos
Water soluble drugs have a _________ volume of distribution, leading to a need for __________ drug doses
- Smaller
- decreased
a little example
NMB , water soluable, have a smaller VD in obese pt’s and dose should be based on IBW
Sevo causes increased levels of serum inorganic fluorides to be metabolizes at a rate a ______% ________ in obese pt’s than in non-obese pts
- 100%
- faster
Obese pt’s frequently have liver impairment due to infiltration of ________ by _________? therfore drugs with hepatic metabolism should be given ______
- hepatocytes
- triglycerides
- cautiously
What is the down and dirty relationship b/t obesity and DM??
- 80% of NIDDM (type II) patiens are obese
- The risk of typeII DM increases linearly with BMI
