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AP II Test 2 > Obesity > Flashcards

Obesity Flashcards

(48 cards)

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1
Q

What BMI is considered being overweight?

What BMI is considered being obese?

What BMI is considered morbidly obese?

A

BMI > 30

BMI > 30 -35

BMI > 40

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2
Q

Obesity is considered being greater than ____% ideal body weight.

A

20%

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3
Q

What is the waist size (M/F) for an obese person?

A

40 male /35 female

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4
Q

Morbidly obese is ___ times ideal body weight.

A

2

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5
Q

What diseases are linked to obesity? (10)

A
  • diabetes
  • heart disease
  • HTN
  • stroke
  • arthritis
  • GERD
  • cancer (endometrial, breast, prostate, colon)
  • high cholesterol
  • endocrine disease
  • REDUCED FERTILITY
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6
Q

What are the types of bariatric surgeries?

A

gastric restriction (AKA gastroplasty)

adjustable gastric banding

gastric restriction with bypass

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7
Q

This is known as:

A

gastric restriction, gastroplasty

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8
Q

What type of gastric restriction is this?

A

adjustable gastric banding

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9
Q

Gastric restriction, both methods, decrease stomach contents by how much?

A

10-20 cc

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10
Q

What is the most common bariatric procedure in Australia and Europe?

A

adjustable banding

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11
Q

Which method is associated with a decreased rate of weight loss?

A

adjustable banding

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12
Q

What is the most common bariatric procedure in the US?

A

gastric bypass

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13
Q

What type of gastric surgery is this?

What is the extension limb called?

A

gastric bypass

Roux limb varies between 75-150 cm

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14
Q

A shorter Roux limb results in greater weight loss. True or false?

A

false, longer one

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15
Q

What is the gold standard of weight loss surgery?

A

bypass

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16
Q

What is the “metabolic syndrome”?

A

Triad of:

Obesity

HTN

Type II DM

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17
Q

Excess body mass leads to what regarding metabolic demand and cardiac output?

A

Increased metabolic demand

Increased CO

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18
Q

What is a result of increased CO with respect to workload and pulmonary flow?

A

Increased workload leading to LVH

Pulmonary HTN → Cor Pulmonale → right heart failure

in short, increases pulmonary flow

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19
Q

What are cardiovascular issues that may result from obesity? (5)

A

Increased risk of arrhythmias
Hypertrophy
Hypoxemia
Fatty infiltration of conduction system
Increased catecholamines

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20
Q

How much CO is needed for each kg of fat? (L/min)

21
Q

During cardiac evaluation of obese pt, assess for: (4)

Study These Flashcards
A

prior MI

HTN

angina

PVD

22
Q

Sudden cardiac death is more prevalent with: (2)

Study These Flashcards
A

LVH

ventricular ectopy

23
Q

What do you need to evaluate in EKG for obese patients? (2)

Study These Flashcards
A

axis deviation

atrial tachyarrhythmias

24
Q

What does this strip indicate?

Study These Flashcards
A

LVH in lead V5

25
Severely obese total body water is ____ %. Estimated blood volume in obese patient is about ____ mL/kg of actual body weight.
40% 50 mL/kg
26
What do you consider when replacing fluid in an obese patient?
avoid rapid rehydration hetastarch at ideal body weight albumin 5-25% as indicated crystalloid for blood loss 3:1
27
What are the respiratory consequences of obesity?
Increased CO2 production Increased O2 consumption
28
In obese patients, treat like they have restrictive lung disease. As a result, you may be encountered with these issues:
decreased chest wall compliance diaphragm forced cephalad decreased lung volumes FRC may fall below closing capacity resulting in alveolar collapse and V/Q mismatch
29
What is the Desaturation Theory?
FRC is reduced by 1.5 L with changing body position.
30
If BMI \> 43, time to desaturate is \< ____ minutes.
2
31
What is the primary source of oxygen reserve during apnea?
expiratory reserve volume
32
What changes will be affected from least to greatest in pulmonary function tests?
tidal volume inspiratory reserve volume expiratory reserve volume greatly reduced
33
What is obesity-hypoventilation called?
Pickwickian syndrome
34
What are the consequences of Pickwickian syndrome?
hypercapnia cyanotic from **hypoxemia** polycythemia pulmonary HTN somnolence sleep apnea OSA biventricular failure
35
What are GI concerns for obese patients? (4)
SEVERE RISK OF ASPIRATION GERD hiatal hernia increased abdominal pressure
36
What is the best treatment for obese patients regarding GI issues?
pre-op with H2 blockers night before surgery!
37
What are pharmacological considerations for obese patients?
increased volume distribution **increased GFR** and clearance of untransformed drugs increased requirements
38
Des results in quicker wake up than Sevo. True or false?
false
39
Since increased volume of distribution in obese patient, what will we do as a result for our induction anesthetics?
give larger loading dose and less frequent maintenance dose
40
What drugs do we dose on ideal body weight and why?
rocuronium water soluble
41
What drugs do we dose on total body weight and why?
propofol, except on induction (use IBW) Sux Versed but will cause somnolence
42
To decrease the risk of aspiration pneumonitis, consider what 2 drugs?
H2 antagonist metoclopramide
43
Difficult ventilation will be attributable to what factors?
age \> 55 snoring lack of teeth BMI \> 26
44
Important induction airway equipment not to forget:
glidescope nasal trumpet introducer
45
What are the 6 D's of difficult airways?
Disproportion Distortion Decreased thyromental distance Decreased inter-incisor (mouth opening distance) Decreased ROM Dental overbite
46
When will we need higher FiO2 with regards to positioning in obese pts?
trendelenberg lithotomy prone
47
What is the best intraoperative position for an obese patient?
reverse trendelenberg
48

AP II Test 2 (7 decks)

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