Wk 13: Obesity Flashcards
(24 cards)
Most common cause of postoperative mortality (Bariatric):
- O______, 2. m____, 3. h___ B_____
Other factors: H___, D___, _____ _____ with bariatric procedures, t___________
Older, men, high BMI
HTN, DM, postop leak with bariatric procedures, thromboembolism
Obesity classifications according to BMI
kg/m2
Less than 18.5: ________
18.5-24.9: __________
25-29.9: __________
30-34.9: _________
35-39.9: __________
>40: ___________
> 50: ___________
60:_____________
Less than 18.5: Underweight
18.5-24.9: Normal
25-29.9: Overweight
30-34.9: Obesity I
35-39.9: Obesity II
>40: Obesity III (Extremely obese)
> 50: Super obese
60: Super-super obese
Drug dosing according to IBW, LBW, TBW. General rule:
Give water soluble drugs according to ______.
Give lipid-soluble drugs according to ______.
IBW
TBW
Dosing of drugs based on IBW, LBW, TBW
PROPOFOL: Induction dose = _____, maintenance dose = _____.
LBW (increased fat mass does not
affect initial distribution/redistribution during induction)
TBW
Dosing of drugs based on IBW, LBW, TBW
SUCCINYLCHOLINE: Intubating dose based on: ______.
TBW
*Exception to water soluble drugs; Even though water soluble drug, based on TBW because combination of an increased blood volume (increased Vd) and increased pseudocholinesterase activity (increased clearance) necessitates TBW dose to be given to ensure adequate paralysis
Dosing of drugs based on IBW, LBW, TBW
Rocuronium, Vecuronium, Nimbex: ______.
IBW
Hydrophilic drugs given according to IBW will ensure shorter duration and a more predictable recovery in this respiratory-challenged population
Dosing of drugs based on IBW, LBW, TBW
Fentanyl, Sufentanil: Loading: _____, Maintenance: ______.
TBW (Increased distribution volume
and elimination time correlate with
degree of obesity)
LBW
Dosing of drugs based on IBW, LBW, TBW
Precedex: Infusion rates of ____mcg/kg/min
0.2
lower than usual infusion rates recommended to minimize adverse cardiac side effects
Dosing of drugs based on IBW, LBW, TBW
Sugammadex: ______.
TBW
Dosing of drugs based on IBW, LBW, TBW
Midazolam: _____.
TBW
Dosing of drugs based on IBW, LBW, TBW
_____ is the most appropriate dose for most anesthetic drugs, with the exception of NDMB (non-depolarizing NMB), where ____ may be more appropriate
LBW
IBW
Drugs given according to IBW (2)
Non-depolarizing NMB: Rocuronium, vecuronium, cisatracirium
Remifentanil
Type of obesity associated with diabetes:
C_______, a_______, or a________ v_______ obesity ( “______” shape) with a waist/hip ratio greater than ____ inches in men, and _____ inches in women, is perceived as a malignant form of fat accumulation
Central, android, or abdominal visceral obesity, “apple” shape
0.85 inches in men
0.92 inches in women
Android (apple) obesity more at risk for:
- h_______ disease
- d______ m________
- b______ cancer
- e _________ cancer
- visceral fat more active, causing decreased ______ sensitivity, increased t_______, decreased _____ cholesterol, increased b____p______, increased f_____ f____ a______ release into blood
Heart disease
diabetes mellitus
breast cancer
endometrial cancer
decreased insulin sensitivity
increased triglycerides
decreased HDL
blood pressure
free fatty acid
Obese have _________ lung disease
restrictive
Respiratory considerations:
Compression of fat on a_______, d_______, and t________ structures
Thoracic _______ and lumbar ______ develop, resulting in impaired rib movement and fixation of the thorax in an _______ position
Chest wall, parenchyma, and pulmonary compliance is reduced to ___% of predicted value
abdominal, diaphragmatic, thoracic
kyphosis, lordosis, inspiratory
35
Respiratory considerations
Metabolic needs of the fat organ and the greater mechanical work of breathing stimulate _____ myocardial oxygen consumption
____ respiratory muscle efficiency - > ___ FRC, p_______ airway closure (FRC below CC), _____ dead space, ____ retention, ____ mismatch, s______, h________
increased
decreased, decreased FRC, premature, increased dead space, CO2, V/Q mismatch, shunting, hypoxemia
Lung volumes
____ declines exponentially with increasing BMI
Decreased ______, _____, and _____ (rapid, shallow breathing)
FRC ____ CC (because lung inflation is inhibited)
OVERALL
Decreased FRC, ERV, VC, TLC
FRC
FRC, ERV, TLC
less than
_____ventilation, hyper_______, and _______ result from depression of CNS responsiveness to chronic hypoxia
Recurrent _________ leads to secondary polycythemia and is associated with increased risk of CAD and cerebrovasular disease
hypoventilation, hypercarbia, acidosis
hypoxemia
Pickwickian syndrome = obesity ________ syndrome (OHS)
Complication of extreme obesity that occurs in ___% of the obese population
Alveolar ventilation is decreased: due to ______, inefficient ventilation related to decreased in _____, inadequate _____ strength, and inadequate elevation of the ________
hypoventilation
8%
shallow
TV
inspiratory
diaphragm
Characteristics of Pickwickian syndrome:
1. _____
2. H__________ ( _____ retention)
3. D______ H____________ (can be inappropriate and sudden)
4. Arterial h__________
5. C__________-induced p__________
6. Respiratory a_______
7. P________ H_____
8. R_____ sided h _______ f_______
9. Extreme: _______ episodes of central apnea (apnea without _______ _______) reflecting progressive desensitization of the respiratory centers to nocturnal hypercapnia
- OSA
- Hypercapnia (CO2)
- Daytime Hypersomnolence
- Arterial hypoxemia
- Cyanosis-induced polycythemia
- Respiratory acidosis
- Pulmonary HTN
- Right sided heart failure
- Extreme: Nocturnal episodes of central apnea (apnea without respiratory efforts) reflecting progressive desensitization of the respiratory centers to nocturnal hypercapnia
Pickwickian syndrome
_______ enlargement, c________, p_______, and t________ are also evident on physical examination
Activities of daily living are altered by the________ episodes
Cardiac enlargement
cyanosis
polycythemia
twitching
somnolent
Pickwickian syndrome
CNS: Decreased central _______ drive
Airway: Potential _____ airway, _____
Cardiovascular: ______ ______ disease, ______ ______ _______
Respiratory: ______ chest physiology, pulmonary _____, ________/ ________
respiratory
difficult, OSA
Coronary artery disease, congestive
heart failure
Restrictive , pulmonary HTN,
hypoxmia/hypercapnia
