Flashcards in Obesity Deck (61)
What is phentermine?
A weight-loss drug (appetite suppressant) that some patients may be on
How is obesity defined?
Weighing 20% more than your ideal body weight
BMI > 30 kg/m2
A BMI > ____ is associated with morbidity due to stroke, ischemic heart disease, DM, and certain cancers
Obese people have a high incidence of ____ within 30 days of surgery.
More likely to die from it if BMI > 40
New research suggests SQ heparin for 3 weeks after surgery
NPO status for obese patients
Need to be NPO for a longer period of time because they have delayed gastric emptying, increased gastric volume, and lower gastric pH
4 major risk factors for post-op PE
BMI > 30, truncal obesity, venous stasis disease, and OSA or OHS (obesity hypoventilation syndrome)
Respiratory conditions associated with obesity
Restrictive lung disease
CV conditions associated with obesity
Ischemic heart disease
Endocrine conditions associated with obesity
Musculoskeletal conditions associated with obesity
Arthritis of weight bearing joints
Malignancies conditions associated with obesity
Resp volume changes associated with obesity
Decreased FRC, ERV, and TV. TV may fall into the range of the closing capacity (cc).
RV is unchanged.
What is closing capacity?
The volume in the lungs at which the alveoli collapse
Obese people should be put to sleep in this position
What effect does the decreased expiratory reserve volume have?
Faster closure of small airways
What should we try to avoid giving to obese patients?
Muscle relaxants. They do not have a long safe apnea time.
Minute ventilation for obese pts are higher/lower than normal
Higher. Remember that obese people have increased oxygen consumption and CO2 production due to increased body mass/tissue.
Do we want to get PFTs on obese pts?
Changes in PFTs don't occur until the obesity worsens to the point where they have restrictive lung disease of pulmonary HTN.
What test of pulmonary function do we normally want to get on the obese?
What will happen if an obese pt has anesthesia induced in the supine position?
All obese patients should have these on during the case to prevent PE
TEDs and SCDs
Why do obese patients have more strain on their hearts?
Increased CO and expanded blood volume (more tissue). Also, if OSA is present, can cause polycythemia, and increased blood viscosity.
Obese patients have limited reserve for
HLD associated with obesity can lead to
Atherosclerosis -> premature CAD and PVD.
Do we want an EKG for obese patients?
They probably have enlarged hearts and vascular disease.
Type of heart failure than obesity with OSA causes
OSA is characterized by
1) Apnea lasting more than 10 seconds despite resp effort against a closed glottis
2) Hypopnea, and partial or intermittent narrowing/closure of the upper airway during sleep, causing a 4% drop in O2 sat
S/S of OSA
Decreased SaO2 during sleep
Excessive day-time tiredness
How is OSA diagnosed?
At least 5 episodes of hypopnea and/or apnea during 1 hour
5-15 = mild
15-30 = moderate
>30 = severe