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Obesity Flashcards

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1
Q

Android vs Gynecoid, which is more common in men?

A

Android

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2
Q

Android vs Gynecoid, which has more central or abdominal fat accumulation?

A

Android

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3
Q

Android vs Gynecoid, which has higher risk for heart disease, death, HTN, HLD, and insulin resistance?

A

Android

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4
Q

Android vs Gynecoid, apple or pear?

A

Android - APPLE

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5
Q

Android vs Gynecoid, which fat is more metabolically active?

A

Android

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6
Q

Android vs Gynecoid, which has increased risk for joint disease and varicose veins?

A

Gynecoid

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7
Q

Android vs Gynecoid, which has reduced risk of non-insulin dependent diabetes?

A

Gynecoid

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8
Q

Android vs Gynecoid, which is more common in women, has a pear shape, and is localized to the glutes and femoral?

A

Gynecoid

“Gyn”

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9
Q

What is metabolic syndrome? Why is this important?

A

Also called X syndrome - a disease that coincides with obesity

Carries a 50-60% greater risk of cardiovascular disease

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10
Q

Diagonostic criteria for metabolic syndrome, fasting glucose?

A

> 110

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11
Q

Diagonostic criteria for metabolic syndrome, BP?

A

> 130/85

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12
Q

Diagonostic criteria for metabolic syndrome, HDL for men and women?

A

<40 for men
< 50 for women

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13
Q

Diagonostic criteria for metabolic syndrome, triglycerides?

A

> 150

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14
Q

Diagonostic criteria for metabolic syndrome, waist circumference for men and women?

A

> 40 inches for men
35 inches for women

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15
Q

BMI photo

A
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16
Q

What is the formula for BMI?

A

= weight in kg / height in meters squared

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17
Q

How to classify obesity in children?

A
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18
Q

How to calculate IBW for men and women?

A
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19
Q

How does obesity create a restrictive ventilatory defect?

A

Chest fat prevents outward expansion

Abdominal fat pushes diaphragm up and compresses the lungs

Kyphosis and lordosis develop and alters the geometry of the ribcage

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20
Q

Do fat people have slow, deep breathes or fast shallow breaths? Why?

A

Rapid - shallow breathing due to being more energy efficient

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21
Q

Describe if fat is metabolically active

A

It is metabolically active - they have increased O2 consumption and CO2 production

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22
Q

Will obese people have a normal PaCO2 or increased? Why?

A

Normal due to the high diffusing capacity of CO2

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23
Q

What is likely to happen if an obese patient has an elevated PaCO2?

A

Signals impending respiratory failure

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24
Q

How does obesity affect FRC?

A

-It is inversely proportional
-The fatter you are, the greater reduction in FRC

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25
How does general anesthesia affect FRC in a normal person and a fat person?
Normal - decrease in FRC by 20% Obese - decrease in FRC by 50%
26
Why do obese people desaturate so fast?
High O2 consumption Decreased FRC
27
How does premature airway closure affect dead space?
Increases dead space
28
obese lung volumes
29
How to reduce atelectasis in an obese patient?
Keep FIO2 < 80% to prevent absorption atelectasis
30
What 2 ways can you recruit collapsed alveoli?
1. 40cm H20 for 10 seconds 2. PEEP or CPAP 5-10 Both may reduce venous return
31
TV for obese patients? Should RR or TV be adjusted?
6-8 mL/kg of IBW Higher TV can cause sheer stress on the lungs so titrate RR
32
Should obese patients be an RSI?
Not alone Take all factors into consideration
33
How does blood volume and CO change in obesity? What does this lead to?
More blood volume and a higher CO lead to cardiovascular complications This is from the fat being metabolically active
34
How does SV and HR change in obesity? CO?
CO is increased due to an increased SV due to increased blood volume HR is usually not changed
35
Does obesity lead to systolic or diastolic dysfunction? Which one first?
First diastolic then systolic failure (biventricular failure)
36
What is HTN a result from in obesity?
Hyperinsulinemia SNS activation RAAS activation Elevated cytokine in plasma
37
CV photo
38
How does EKG voltage change in obesity?
Decreased amplitude from distance between heart and leads
39
How does QT change in obesity?
Prolongation which increases sudden death
40
How does axis deviation change in obesity?
Left axis - stomach pushes the heart up to the left. Plus LVH and fluid overload contribute to this Right axis - RVH from OSA and volume overload
41
How does cardiac ischemia happen in obesity?
Decreased O2 supply and demand
42
How do dysrhythmias happen in obesity?
Caused by fatty infiltrates of the conduction system
43
What valvular defect is highly suggestive of pulmonary HTN in obesity?
Tricuspid regurg on TEE
44
How is the volume of distribution affected by obesity?
1. Increased blood volume - need more drug 2. Increased CO - faster delivery to vessel rich group 3. Altered plasma protein bunding - free fractions available 4. Lipid solubility - more fat (lipids) higher Vd
45
How does obesity affect Vd of lipophilic and hydrophilic drugs?
Both are increased
46
Is MAC changed by obesity?
No
47
Which anesthetic gas has the faster emergence ?
1. Sevo 2. Des 3. Iso 4. Propofol
48
Should nitrous be avoided? Why or why not?
Generally avoided because it restricts the maximum FiO2 that can be delivered
49
Should agents with the lowest or highest blood: gas coefficients be used?
Agents with the lowest
50
How should propofol be dosed on obese? Induction of Maintenace?
Induction - LBW Maintenace - TBW
51
What is one water soluble drug that should be dosed on TBW? Why?
Succ - due to increased blood volume and increased pseudocholinesterase activity
52
How is roc and vec dosed?
LBW
53
How is cis and atracurium dosed?
TBW
54
How are opioids dosed? Why? Which is the exception?
Induction based on TBW Maintenace is based on LBW Remi is different because of the plasma esterases - use LBW
55
How does obesity affect epidural dosing?
Engorgement of epidural veins and increased epidural fat cause a GREATER spread. Reduce dose by 75%
56
Which muscles open the airway?
57
Define hypopnea
50% reduction in airflow for 10 seconds, 15 or more times per hour This is linked to snoring and decreased O2 saturation
58
How is OSA defined?
Cessation of airflow for at least 10 seconds with 5 or more unsuccessful efforts to breathe and a greater than 4% reduction in SaO2
59
OSA photo
60
What is the definitive test for OSA?
Polysomnography Number of episodes / hours of sleep
61
How is mild, moderate, and severe OSA calculated?
62
What is stop bang?
63
What is obesity hypoventilation syndrome? How is it identified?
Long term consequence of untreated OSA -The respiratory center fails to respond to hypercarbia ****apnea during sleep WITHOUT any respiratory effort BMI > 30 Awake PaCO2 > 45 Dysfunctional breathing during sleep
64
Which bariatric surgeries are likely to cause malnutrition?
Roux-en-Y Biliopancreatic diversion
65
OSA is defined as a cessation of airflow for how many seconds? What is the drop in SaO2?
10 seconds At least 4% deduction in SaO2
66
Which conditions contribute to HTN in the obese population?
Hyperinsulinemia Cytokines Angiotensinogen
67
What is the most effective weight loss surgery?
Roux - en - Y
68
One gram of fat is equal to how many calories? What about carbs and protein?
Fat - 9 calories Protein - 4 calories Carb - 4 calories
69
How to convert inches to m2?
70
Is RV reduced in obesity?
No
71
Are lung volumes and VC increased or decreased in obesity?
Decreased
72
Is lung compliance increased or decreased in obesity?
Decreased
73
Is there a change in airflow obstruction in obesity?
No change
74
What should the goal be for preoxygenation for obesity?
100% FiO2 + CPAP of 10cm until end tidal exceeds 90% This will prolong the time to desaturation by 50%
75
How long can postoperative hypoxemia occur after surgery?
Immediately and up to 5 days after
76
5 strategies to maximize postop oxygenation?
1. CPAP or BIPAP 2. HOB 30 degrees 3. Early ambulation 4. Pain control without narcs 5. IS
77
Why does CO change in obesity?
Due to increased Stroke volume from increased blood volume HR stays the same
78
How is versed dosed for loading and maintenance?
BOTH TBW
79
Is the absorption of drugs orally changed in obesity?
No
80
How is remifent dosed for loading and maintenance?
BOTH LBW
81
Most common signs of gastric leak? How often?
2% chanc Tachycardia Fever Abdominal pain
82
Which appetite suppressant is associated with serotonin syndrome?
Sibutramine
83
Is there an increased incidence of pulmonary aspiration based on BMI alone?
No
84
Does a hiatal hernia increase the risk of aspiration?
Yes
85
What should fluid requirements be based on in the obese population?
LBW

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