Anesthesia and Obesity Flashcards
(90 cards)
1
Q
predicted body weight
A
similar to IBW
2
Q
MALE: PWB
A
(KG) = 50 + (0.91 X HEIGHT IN CM – 152.4)
3
Q
FEMALE: PWB
A
FEMALE: PWB (KG) = 45.5 + (0.91 X HEIGHT IN CM – 152.4)
4
Q
1 meter=ft
A
3.28ft
5
Q
1 meter = cm
A
100cm
6
Q
1ft=meters
A
0.3meters
7
Q
1in=cm
A
2.54cm
8
Q
BMI=
A
weight (KG) /HT(meters)2
9
Q
does BMI distinguish between overweight and overfat?
A
IT CANNOT DISTINGUISH BETWEEN OVERWEIGHT AND OVERFAT VERSUS HEAVILY MUSCLED AND CAN BE EASILY CLASSIFIED AS OVERWEIGHT USING BMI
10
Q
does BMI take age, distribution into consideration
A
no, OTHER FACTORS SUCH AS AGE, FAT, CONTENT, AND DISTRIBUTION (WAIST CIRCUMFERENCE AND WAIST TO HIP RATIO)
11
Q
normal BMI
A
18.5-24.9
12
Q
underweight bmi
A
<18.5
13
Q
overweight bmi
A
25-29.9
14
Q
obese 1 bmi
A
30-34.9
15
Q
obesity 2 bmi
A
35-39.9
16
Q
morbid obesity III bmi
A
> /equal 40
17
Q
obesity class II risk of systemic disease
A
increased
18
Q
GYNECOID:
A
PERIPHERAL OBESITY: ADIPOSE TISSUE IS LOCATED PREDOMINANTLY IN THE HIPS, BUTTOCKS, AND THIGHS. THIS FAT IS LESS METABOLICALLY ACTIVE SO IT IS LESS CLOSELY ASSOCIATED WITH CVD.
19
Q
VISCERAL FAT:
A
PARTICULAR ASSOCIATED WITH CARDIOVASCULAR DISEASE AND LVD (LEFT VENTRICLE DYSFUNCTION)
20
Q
ANDROID: CENTRAL OBESITY:
A
ADIPOSE TISSUE IS LOCATED PREDOMINANTLY IN THE UPPER BODY (TRUNCAL DISTRIBUTION) AND IS ASSOCIATED WITH INCREASE OXYGEN CONSUMPTION AND INCREASE INCIDENCE OF CARDIOVASCULAR DISEASE
21
Q
waist circumference correlate with what?
A
abdominal fat and is an independent risk predicator of disease
22
Q
PATHOLOGY AND ANATOMIC DISTRIBUTION OF BODY FAT
A
BODY CIRCUMFERENCE INDICES SUCH AS WAIST CIRCUMFERENCE, WAIST-TO-HEIGHT RATIO, AND WAIST-TO-HIP RATIO HELP TO CLASSIFY THESE PATTERNS OF OBESITY (EX: ANDROID vs GYNECOID OBESITY) AND CORRELATE WITH MORTALITY AND THE RISK FOR DEVELOPING OBESITY RELATED DISEASE.
23
Q
PHENTERMINE (adipex-p)
A
PHENTERMINE (ADIPEX-P): APPROVED FOR USE 3 MONTHS AT A TIME. CAN INDUCE TACHY PALPITATIONS, HYPERTENSION. CAN BE ADDICTIVE AND HAVE WITHDRAWAL SYMPTOMS
24
Q
what needs to be considered prior to surgery with phentermine
A
NEEDS TO BE STOPPED PRIOR TO SURGERY. CAN HAVE SAME EFFECTS AS AN AMPHETAMINE (CARDIAC ETC. ). SEE YOUR INSTITUTION FOR HOW LONG PRIOR TO SURGERY THIS DRUG NEEDS TO BE STOPPED
25
when should you stop phentermine
HAVE SEEN AS LITTLE AS 48 HOURS AND AS LONG AS 3 WEEKS WHEN IT COMES TO STOPPING PHENTERMINE
26
PHENTERMINE AND TOPAMAX (COMBO): will show what?
PHENTERMINE AND TOPAMAX (COMBO): DRY MOUTH, PARESTHESIAS, CONSTIPATION, INSOMNIA, DIZZINESS
27
DECREASED LUNG COMPLIANCE
FAT ACCUMULATION ON THORAX AND ABDOMEN RESULTS IN DECREASE CHEST WALL AND LUNG COMPLIANCE
28
obesity have what for their respiratory system
INCREASE IN OVERALL BLOOD VOLUME AND PULMONARY BLOOD VOLUME
29
tell me about obesity and lung compliance and elastic resistance
INCREASED ELASTIC RESISTANCE AND DECREASE IN CHEST WALL COMPLIANCE ARE FURTHER REDUCED WHEN SUPINE RESULTING IN SHALLOW AND RAPID BREATHING AND LIMITED MAXIMUM VENTILATORY CAPACITY. RESPIRATORY MUSCLES EFFICIENCY ARE BELOW NORMAL
30
what is the most commonly reported abnormalities of pulmonary function in obese patients
decrease in FRC and ERV
31
what is the decreased FRC, VC and total lung capacity result of
reduced expiratory reserve volume
32
what is the relationship between FRC and closing capacity (volume at which small airways begin to close)
volume at which small airways begin to close is adversely affected
33
what occurs with 02 consumption and co2 even at rest
obesity increases 02 consumption and co2 production even at rest
34
anesthesia and supine position decreases FRC up to what percent in obesity compared to what percent in non obese patients
50% obese
| 20% non obese
35
reduced FRC
REDUCED FRC (DUE TO DECREASE ERV) CAN RESULT IN LUNG VOLUMES BELOW CLOSING CAPACITY IN THE COURSE OF NORMAL TIDAL VENTILATION, LEADING TO SMALL AIRWAY CLOSURE, VENTILATION-PERFUSION MISMATCH, RIGHT TO LEFT SHUNTING AND ARTERIAL HYPOXEMIA.
36
OSA is more likely to be cause by what
excessive soft tissue
37
PHYSIOLOGICAL ABNORMALITIES R/T OSA
HYPOXEMIA, HYPERCAPNEA
PULMONARY HPTN, SYSTEMIC VASOCONSTRICTION
SECONDARY POLYCYTHEMIA FROM RECURRENT HYPOXEMIA
INCREASED RISK OF ISCHEMIC HEART DISEASE
CEREBROVASCULAR DISEASE
RV FAILURE D/T HYPOXIC PULMONARY VASOCONSTRICTION
38
Gold standard diagnostic test for OSA
polysomnography (OPS)/sleep study
39
what can we consider pre-op for severe OSA
CPAP
40
what does obesity hypoventilation syndrome or pickwickian syndrome result from
long term OSA- seen in 5-10% of morbid obese
41
what medical conditions result from OHS, Obesity, hypoventilation
pulmonary HTN, Cor pulmonale, alteration in function and structure of the RV
42
where is an obese patient is the extra blood volume distributed
distributed in the fat.
43
what does cardiac output do with obesity
cardiac output will be increased
44
why does cardiac output increase and by as much as how what
increasing weight will increase as much as 20-30ml/kg of excess body fat b/c of ventricular dilation and increases in sv
45
increased blood volume in obese patients
non obese patient
70ml/kg
50ml/kg
46
what happens with increased LV wall stress
leads to hypertrophy, reduced compliance and impairment of LV filling (diastolic dysfunction) with elevated lvdp and pulmonary edema
47
every 10kg of weight gain increase bp sys and dia by what
3-4mmhg increase systolic
2mmhg increase diastolic
48
how does the renin angiotensin system play a role in obesity
increased circulating levels of antiotensinogen, aldosterone, and angiotensin- converting enzyme
49
5% decrease in weight leads to reduce in what?
Sifnigicant reduction in renin antiotensinogen system
50
Gi system and obestiy
gastric volume and acidity are increase
51
GI system and liver function
liver function is altered and drug metabolism is adversely affected
52
NPO can still have how much gastric fluid in stomach
>25cc gastric fluid
53
what does regurgitation of acidic stomach contents leads to
pneumonitis
54
75% larger stomach volume + increased risk fo hiatal hernia, GERD, delayed gastric emptying, higher acidity, increased and pressure results in increase risk of ?
aspiration and pneumonitis
55
unpremediacted, non diabetic fasting obese surgical patients who are free from significant GI pathology are unlikely to have what
high volumes low PH gastric contents after routine prep fasting
56
obese /non obese- do they follow the same NPO guidelines
same NPO guidelines
57
Sevo and obese pateitns
sevo hides in the fat
58
when are we careful with des and obese patients
transient tachycardia
59
abnormalities of the liver associated with obesity include
FATTY INFILTRATION, HIGH PREVALENCE OF NONALCOHOLIC FATTY LIVER DISEASE OR NAFLD. NONALCOHOLIC STEATOHEPATITIS OR NASH, FOCAL NECROSIS, AND CIRRHOSIS.
60
issues with DM
wound healing, MI
61
25% of obese patients have which disorder
potential subclinical hypothyroidism
62
TSH level frequently elevated suggesting the possibility that obesity leas
to a taste of thyroid hormone resistance in peripheral tissues
63
type II Dm related resistance of what
peripheral adipose tissue to insulin.
64
regional is being used more frequently what are the advantages of it
decrease use of opioids , minimal or reduced manipulation of the airway administration of fewer meds with cardiopulmonary depression, decrease nausea and vomiting postoperatively, better post op pain control imposed post op outcomes
65
higher rate of block failure
technical difficulties landmarks
66
SIGNIFICANT KEY FACTORS IN LAW SUITS:
SUBOPTIMUM MONITORING OF PULSE OX, ETCO2 OR BOTH.
67
MAC- monitoring oxygen is important due to
high risk of respiratory depression
68
MAC use
opioids, benzo propofol cautiously and monitor co2 and sat
69
what is peep used for
it is the only parameter that has consistently been shown to improve respiratory function in obese subjects
70
further increase VT only increases the peak inspiratory airway pressure, end expiratory airway pressure and lung compliance without significantly improving arterial oxygenation
vt
71
what should vt be maintained at
6 - 8 mL/kg PWB TIDAL VOLUME SINCE HIGHER TIDAL VOLUMES OFFER NO ADDED ADVANTAGES DURING MECHANICAL VENTILATION OF ANESTHETIZED MORBIDLY OBESE PATIENTS
72
does obesity imply lung growth
no
73
obese patients are more likely to be exposed to higher volumes due to
miscalculations of PBW or IBW
74
mechanical ventilation exposed to higher airway pressures dt decreased respiratory system
compliance
75
why is bleeding increase in the obese patient
dt difficulty accessing surgical site larger incisions extensive dissection
76
AVOID RAPID INFUSION OF IVF D/T PRE-EXISTING CHF
AND THE KNOWLEDGE CHF DIAGNOSED OR UNDIAGNOSED CAN BE AN ISSUE WITH OBESE. THE USE OF IBW ESTIMATES AND APPROPRIATE MONITORING CAN HELP AVOID HYPERHYDRATION
77
DEXMEDETOMIDIN
ALPHA-2 AGONIST WITH SEDATION AND ANALGESIC PROPERTIES, HAS NO SIGNIFICANT ADVERSE EFFECT ON RESPIRATIONS. IT CAN REDUCE POST OP OPIOID ANALGESIC REQUIREMENTS
78
using peep during induction will do what
combat peri induction hypoxemia
79
HYPOTHYROIDISM ASSOCIATED WITH
HYPOTHYROIDISM ASSOCIATED WITH HYPOGLYCEMIA, HYPONATREMIA, AND IMPAIRED HEPATIC DRUG METABOLISM
80
OBESITY ASSOCIATED WITH GLOMERULAR HYPERFILTRATION .
EXCESSIVE WEIGH GAIN INCREASES RENAL TUBULAR REABSORPTION AND IMPAIRS NATRIURESIS THROUGH ACTIVATION OF THE SYMPATHETIC AND RENIN-ANGIOTENSIN SYSTEMS AS WELL AS PHYSICAL COMPRESSION
81
ORLISTAT (OTC ALLI RX XENICAL)
ORLISTAT (OTC ALLI RX XENICAL): BLOCKS ABSORPTION OF DIETARY FAT. IMPROVES OF BP, FASTING BLOOD SUGAR, AND LIPID PROFILES.
ORLISTAT: CHRONIC USE: FAT-SOLUBLE VITAMIN DEFICIENCY. PROLONGED PROTHROMBIN TIME WITH A NORMAL PTT MAY REFLECT VITAMIN K DEFICIENCY. SHOULD BE CORRECTED 6-24 HOURS BEFORE ELECTIVE SURGERY
82
be mindful of other drugs patient may be using for weight loss such as
herbs- look them up
83
what is the most effective treatment for morbid obesity class 3
bariatric surgery
84
malaabsorptive: jejunoileal bypass and biliopancreatic diversion - are these used today
rarely
85
restrictive vertical band- gastroplasty and adjustable gastric banding
used today
86
combined procedures
roux-en-y gastric bypass combines gastric restriction iwht a minimal degree of malaabsorption
87
less invasive technique implantable gastric stimulator
placed by lap stops peristalsis to make patient feel full has issues
88
most effective bariatric procedure
RYGB IS MOST EFFECTIVE BARIATRIC PROCEDURE TO PRODUCE SAFE SHORT AND LONG TERM WEIGHT LOSS IN SEVERELY OBESE PATIENTS.
89
what is associated with less post op pain, lower morbidity, faster recovery and less third spacing of fluid
LAP BARIATRIC SURGERY IS ASSOCIATED WITH LESS POSTOP PAIN, LOWER MORBIDITY, FASTER RECOVERY, AND LESS “THIRD-SPACING” OF FLUID
90
What is the only parameter that has consistently been shown to improve respiratory function in obese subjects?
PEEP
