Obesity & Its Anesthetic Considerations Flashcards Preview

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Flashcards in Obesity & Its Anesthetic Considerations Deck (28):
1

What percent of the US population is overweight?

50

2

What percent of the US population is obese?

22

3

True or false: Obesity is the second most common cause of death in the US

True

4

Define overweight, obese, and morbidly obese in terms of BMI

BMI > 24 = overweight
BMI 28-35 = obese
BMI > 40 = morbid obesity

5

List some diseases linked to obesity

Diabetes
Coronary heart disease
High blood pressure
Stroke
GERD
Arthritis
Cancer
High cholesterol
Endocrine diseases

6

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

Adjustable Gastric banding

7

What is the most common bariatric procedure in the US?

Roux en Y

8

What is metabolic syndrome?

The triad of obesity, Hypertension, And type II diabetes

9

What effect does obesity have on cardiovascular pathophysiology?

It increases the metabolic demand therefore increasing the cardiac output

10

For every 13.5 kg of fat gained What happens to the vascularization and cardiac output?

2.5 miles of neovascularization occurs
Increased cardiac output of 0.01 L/min for each kg of fat

11

What should you assess in the cardiac evaluation of an obese patient?

History of prior MI
HTN
Angina
PVD

12

Which lead looks at the largest amount of muscle mass for the left ventricle?

V5

13

What is indicative of LVH on EKG?

Peaked R waves

14

What is the difference in total body water percentage in the average adult versus the severely obese

The adult total body water percentage is 60 to 65%
Severely obese total body water is 40%

15

How does the estimated blood volume it differ in an obese patient versus a nonobese

Estimated blood volume in an obese patient is 45 to 55 mL/kg actual bodyweight
70 mL/kg for the non-obese

16

What effect does obesity have on respiratory pathophysiology

Increases CO2 production and oxygen consumption

17

Obese people are more susceptible to what type of lung disease

Restrictive lung disease

18

Why is pre-oxygenation so important in obese patients?

Because they have a decreased FRC

19

FRC is composed of what

FRC = ERV + RV

20

What is Pickwickian syndrome?

Obesity usually extreme
Hypercapnia
Polycythemia
Hypoxemia
Pulmonary hypertension
Somnolence
OSA

21

What effects does obesity have G.I. pathophysiology?

Increased risk for aspiration
Increased incidence of GERD and hernias

22

What are some pharmacological considerations for obese patients?

Increased volume of distribution
Increased GFR
Increased fat stores

23

What are some anesthetic considerations for induction on an obese patient

Prepare for difficult intubation
Prepare for difficult mask ventilation
Induction may cause airway collapse
Increased risk for aspiration

24

What is one way to help facilitate intubation on an obese patient

Ramping

25

What do you always want to have in prior to extubation for an obese patient

Airway!
NAW or OAW

26

What are the six D's of a difficult airway?

1. Disproportion of tongue size
2. Distortion (neck mass)
3. Decreased thyromental distance
4. Decreased Mouth opening
5. Decreased motion of the C-spine
6. Dental overbite

27

What is the best intraoperative position for obese patients

Reverse Trendelenburg

28

What are two important considerations after extubation of an obese patient

Keep their head up and supply oxygen