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Flashcards in Obesity Deck (61)
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1

What is phentermine?

A weight-loss drug (appetite suppressant) that some patients may be on

2

How is obesity defined?

Weighing 20% more than your ideal body weight

or

BMI > 30 kg/m2

3

A BMI > ____ is associated with morbidity due to stroke, ischemic heart disease, DM, and certain cancers

30

4

Obese people have a high incidence of ____ within 30 days of surgery.

PE
More likely to die from it if BMI > 40
New research suggests SQ heparin for 3 weeks after surgery

5

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

6

4 major risk factors for post-op PE

BMI > 30, truncal obesity, venous stasis disease, and OSA or OHS (obesity hypoventilation syndrome)

7

Respiratory conditions associated with obesity

OSA/OHS
Restrictive lung disease
Pulmonary HTN

8

CV conditions associated with obesity

HTN
Cardiomegaly
Ischemic heart disease
Cerebrovascular disease
PVD
DVT
HLD
Sudden death

9

Endocrine conditions associated with obesity

DM
Hypothyroidism
Cushing Syndrome

10

Musculoskeletal conditions associated with obesity

Arthritis of weight bearing joints
Back pain

11

Malignancies conditions associated with obesity

Colorectal
Breast
Prostate
Uterine
Cervical

12

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.

13

What is closing capacity?

The volume in the lungs at which the alveoli collapse

14

Obese people should be put to sleep in this position

Reverse-T

15

What effect does the decreased expiratory reserve volume have?

Faster closure of small airways

16

What should we try to avoid giving to obese patients?

Muscle relaxants. They do not have a long safe apnea time.

17

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.

18

Do we want to get PFTs on obese pts?

Not usually.
Changes in PFTs don't occur until the obesity worsens to the point where they have restrictive lung disease of pulmonary HTN.

19

What test of pulmonary function do we normally want to get on the obese?

ABG

20

What will happen if an obese pt has anesthesia induced in the supine position?

Rapid desaturation***

21

All obese patients should have these on during the case to prevent PE

TEDs and SCDs

22

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.

23

Obese patients have limited reserve for

Hypotension
HTN
Tachycardia
Fluid overload

24

HLD associated with obesity can lead to

Atherosclerosis -> premature CAD and PVD.
Pancreatitis.

25

Do we want an EKG for obese patients?

Hell yea!
They probably have enlarged hearts and vascular disease.

26

Type of heart failure than obesity with OSA causes

Biventricular failure

27

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

28

S/S of OSA

Snoring
Decreased SaO2 during sleep
Morning HA
Impaired concentration
Excessive day-time tiredness

29

How is OSA diagnosed?

At least 5 episodes of hypopnea and/or apnea during 1 hour

5-15 = mild
15-30 = moderate
>30 = severe

30

Risk factors for OSA?

Obese
Middle aged
Males
ETOH
Sleep aid drugs
Abdominal fat distribution
Neck girth
( > 16 for women and > 17 for men)