Advanced | Obesity and Anesthesia in Bariatric Surgery Flashcards
A 40 year old male, classified as Obese class II is scheduled for Laparoscopic cholecystectomy. Which of the following ventilatory parameter will MOST likely improve his respiratory function perioperatively?
A. PEEP
B. TV
C. Pressure support
D. SIMV
A. PEEP
Is the only ventilatory parameter that has consistently been shown to improve respiratory function in obese patients.
It is the weight associated with the lowest mortality rate for a given height and gender:
A. IBW
B. LBW
C. Actual body weight
D. Total body weight
A. IBW
Mr. John came in for pre-operative screening. His BMI is 38. Which of the following category should he belong?
A. Obese Class II
B. Super obese
C. Obese Class III
D. Super-super obese
A. Obese Class II
Mr. Smith, a known Obese Class II claimed to have had several visits to his primary care physician for the management of his obesity. He mentioned that his appetite significantly decreased after taking a prescribed medication for several weeks. While he did experience occasional tachycardia and hypertension, he noted that his appetite remained notably reduced. Which medication did he took?
A. Phentermine (Adipex-P)
B. topiramate (Topamax)
C. Lorcaserin
D. Bupropion
A. Phentermine (Adipex-P)
Is primarily a noradrenergic and possibly dopaminergic sympathomimetic amine that decreases appetite. Although it is only approved for 3 months’ use, it can induce, tachycardia, palpitations, and hypertension, as well as dependence, abuse, and withdrawal symptoms.
Is combined with naltrexone and is a dopamine and norepinephrine reuptake inhibitor which stimulates pro-opiomelanocortin neurons.
A. Phentermine (Adipex-P)
B. topiramate (Topamax)
C. Lorcaserin
D. Bupropion
D. Bupropion
Which of the following parameters is most commonly reported as abnormal in the pulmonary function of obese patients?
A. Decreased IRV
B. Decreased ERV
C. Decreased TLC
D. Decreased closing capacity
B. Decreased ERV
Decreased FRC and Decreased ERV are the two most commonly altered pulmonary function.
____ is the reduction of FRC occurring in obese patients during general anesthesia?
A. 50%
B. 70%
C. 30%
A. 50%
Anesthesia and supine positioning worsen this situation such that up to a 50% reduction in FRC occurs in the obese anesthetized patient compared with * 20% in the nonobese individual
It is the most sensitive indicator of the effect of obesity on pulmonary function:
A. ERV
B. FRC
C. TLC
A. ERV
This is the gold standard technique for diagnosing OSA:
A. STOB-BANG questionnaire
B. Overnight polysomnography
C. Clinical diagnosis
D. Apnea–hypopnea index
B. Overnight polysomnography
A 30 year old female is scheduled for elective surgery. She is Obese class II without hypertension. During pre-op rounds, she mentioned that she underwent polysomnography abroad with a AHI (apnea–hypopnea index) of 12 events per hour. This means that her OSA is:
A. Mild
B .Moderate
C. Severe
D. Normal
A. Mild
The diagnosis of OSA can only be made in patients who undergo polysomnography, or a home sleep study.
Results of polysomnography are reported as the apnea–hypopnea
index (AHI), which is derived from the total number of apneas and hypopneas divided by the total sleep time or the respiratory disturbance index (RDI).
Most sleep centers commonly use an AHI between 5 and 10 events per hour as a normal limit.
Mild Disease: AHI of 5 to 15 events per hour
Moderate Disease: AHI of 15 to 30 events per hour
Severe Disease: AHI of greater than 30 events per hour
Which of the following is NOT a component of Obesity Hypoventilation (Pickwickian) Syndrome?
A. BMI >30
B. Awake arterial hypercapnia (>45 paco2)
C. No known causes of hypoventilation
D. Asleep O2 sats 92% or less
D. Asleep O2 sats 92% or less
- Obesity Hypoventilation (Pickwickian) Syndrome Is a combination of obesity and chronic hypoventilation that is frequently misdiagnosed and untreated, resulting in pulmonary hypertension and cor-pulmonale, increased risk of postoperative complications, and death.
The following clotting factors are consistently increased in obese patients EXCEPT?
A. Fibrinogen
B. X
C. VIII
D. vWf
B. X
FACTORS ELEVATED in OBESE patient:
Fibrinogen
VII
VIII
vWf
PAI-1
- Von Willy is riding his new F-78 jet!:)
Among obese patients, which clotting factor is highly correlated with increased cardiovascular mortality.
A. Factor I (Fibrinogen)
B. Factor II (Prothrombin)
C. Factor VIII (Anti-hemophilic A)
D. Factor IV (calcium)
C. Factor VIII (Anti-hemophilic A)
An increase of more than ___ kg/m2 in BMI is associated with a 2.7-fold increase in risk for developing new reflux symptoms.
A. 3.5
B. 10
C. 5
D. 1.5
A. 3.5
In general, this is the most common biochemical abnormality in obese patients?
A. Elevated ALT
B. Elevated AST
C. Elevated APTT
D. Elevated Creatinine
A. Elevated ALT
TRUE or FALSE
A drug that is mainly distributed to lean tissues should have the loading dose calculated based on LBW.
TRUE
The following are physiologic abnormalities resulting from OSA EXCEPT:
A. Hypoxemia
B. Hypercapnia
C. Pulmonary hypertension
D. Polycythemia
E. Respiratory Alkalosis
E. Respiratory Alkalosis
Barash | 9th Edit
The following pulmonary physiology is altered in Obese patients EXCEPT:
A. Increased pulmonary blood volume
B. Decreased closing capacity
C. Decreased ERV
D. Decreased lung compliance
B. Decreased closing capacity
Which of the following drug metabolism is ENHANCED among obese patients?
A. Oxidation
B. Reduction
C. Hydrolysis
D. Sulfation
**D. Sulfation **
Drugs that undergo phase I metabolism (oxidation, reduction, hydrolysis) are generally unaffected by changes induced by obesity, whereas phase II reactions (glucuronidation, sulfation) are enhanced.
Barash | 9th Edit
Compounds that are less lipophilic typically show little or no change in their volume of distribution (VD) with obesity. However, highly lipophilic drugs are exception to this rule. Which of the following drug follows this rule?
A. Remifentanil
B. Succinylcholine
C. Tetracaine
D. Rocuronium
E. Thiopental
A. Remifentanil
Less lipophilic compounds have little or no change in VD with obesity. Exceptions to this rule include the highly lipophilic drugs:
- Procainamide
- Remifentanil
- Digoxin
PPRD (Tatay Digong is exceptional).:)
Among obese patients, Sugammadex when used as reversal agent must be based on:
A. Actual body weight
B. Lean body weight
C. Total body weight
A. Actual body weight
A recent study evaluated recovery times after reversal of neuromuscular blockade with sugammadex in obese (BMI >30 kg/m) and nonobese (BMI <30 kg/m) patients, and found that recovery time did not correlate with BMI.
- Sugammadex dosing can therefore be based on actual
body weight in both obese and nonobese patients.
Which of the following anesthetic drugs, when given thru parenteral route, must be based on TOTAL BODY WEIGHT?
A. Rocuronium
B. Neostigmine
C. Fentanyl
D. Sugammadex
E. Thiopental
B. Neostigmine
Drugs wherein the dosing should be based on TOTAL BODY WEIGHT are the following:
- Propofol (maintenance)
- Succinylcholine (pseudocholinesterase activity increases)
- Dexmedetomidine
- Neostigmine
IV bolus of benzodiazepine in obese patients must be based on:
A. Actual body weight
B. Ideal body weight
C. Total body weight
B. Ideal body weight
- Continuous IV infusion should be based on actual body weight
In combination with clinical findings, which of the following is the most common echocardiographic finding that can clinically help confirm pulmonary hypertension?
A. Tricuspid regurgitation
B. Mitral regurgitation
C. borderline low ejection fraction
A. Tricuspid regurgitation
Tricuspid regurgitation on echocardiography is the most useful confirmatory
test of pulmonary hypertension but should be combined with clinical
evaluation.
