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Spring '20/ L. BASICS- Immune, OR Hazards, OP > Anesthesia and Obesity > Flashcards

Anesthesia and Obesity Flashcards

1
Q

predicted body weight

A

similar to IBW

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2
Q

MALE: PWB

A

(KG) = 50 + (0.91 X HEIGHT IN CM – 152.4)

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3
Q

FEMALE: PWB

A

FEMALE: PWB (KG) = 45.5 + (0.91 X HEIGHT IN CM – 152.4)

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4
Q

1 meter=ft

A

3.28ft

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5
Q

1 meter = cm

A

100cm

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6
Q

1ft=meters

A

0.3meters

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7
Q

1in=cm

A

2.54cm

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8
Q

BMI=

A

weight (KG) /HT(meters)2

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9
Q

does BMI distinguish between overweight and overfat?

A

IT CANNOT DISTINGUISH BETWEEN OVERWEIGHT AND OVERFAT VERSUS HEAVILY MUSCLED AND CAN BE EASILY CLASSIFIED AS OVERWEIGHT USING BMI

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10
Q

does BMI take age, distribution into consideration

A

no, OTHER FACTORS SUCH AS AGE, FAT, CONTENT, AND DISTRIBUTION (WAIST CIRCUMFERENCE AND WAIST TO HIP RATIO)

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11
Q

normal BMI

A

18.5-24.9

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12
Q

underweight bmi

A

<18.5

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13
Q

overweight bmi

A

25-29.9

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14
Q

obese 1 bmi

A

30-34.9

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15
Q

obesity 2 bmi

A

35-39.9

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16
Q

morbid obesity III bmi

A

> /equal 40

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17
Q

obesity class II risk of systemic disease

A

increased

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18
Q

GYNECOID:

A

PERIPHERAL OBESITY: ADIPOSE TISSUE IS LOCATED PREDOMINANTLY IN THE HIPS, BUTTOCKS, AND THIGHS. THIS FAT IS LESS METABOLICALLY ACTIVE SO IT IS LESS CLOSELY ASSOCIATED WITH CVD.

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19
Q

VISCERAL FAT:

A

PARTICULAR ASSOCIATED WITH CARDIOVASCULAR DISEASE AND LVD (LEFT VENTRICLE DYSFUNCTION)

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20
Q

ANDROID: CENTRAL OBESITY:

A

ADIPOSE TISSUE IS LOCATED PREDOMINANTLY IN THE UPPER BODY (TRUNCAL DISTRIBUTION) AND IS ASSOCIATED WITH INCREASE OXYGEN CONSUMPTION AND INCREASE INCIDENCE OF CARDIOVASCULAR DISEASE

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21
Q

waist circumference correlate with what?

A

abdominal fat and is an independent risk predicator of disease

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22
Q

PATHOLOGY AND ANATOMIC DISTRIBUTION OF BODY FAT

A

BODY CIRCUMFERENCE INDICES SUCH AS WAIST CIRCUMFERENCE, WAIST-TO-HEIGHT RATIO, AND WAIST-TO-HIP RATIO HELP TO CLASSIFY THESE PATTERNS OF OBESITY (EX: ANDROID vs GYNECOID OBESITY) AND CORRELATE WITH MORTALITY AND THE RISK FOR DEVELOPING OBESITY RELATED DISEASE.

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23
Q

PHENTERMINE (adipex-p)

A

PHENTERMINE (ADIPEX-P): APPROVED FOR USE 3 MONTHS AT A TIME. CAN INDUCE TACHY PALPITATIONS, HYPERTENSION. CAN BE ADDICTIVE AND HAVE WITHDRAWAL SYMPTOMS

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24
Q

what needs to be considered prior to surgery with phentermine

A

NEEDS TO BE STOPPED PRIOR TO SURGERY. CAN HAVE SAME EFFECTS AS AN AMPHETAMINE (CARDIAC ETC. ). SEE YOUR INSTITUTION FOR HOW LONG PRIOR TO SURGERY THIS DRUG NEEDS TO BE STOPPED

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25
Q

when should you stop phentermine

A

HAVE SEEN AS LITTLE AS 48 HOURS AND AS LONG AS 3 WEEKS WHEN IT COMES TO STOPPING PHENTERMINE

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26
Q

PHENTERMINE AND TOPAMAX (COMBO): will show what?

A

PHENTERMINE AND TOPAMAX (COMBO): DRY MOUTH, PARESTHESIAS, CONSTIPATION, INSOMNIA, DIZZINESS

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27
Q

DECREASED LUNG COMPLIANCE

A

FAT ACCUMULATION ON THORAX AND ABDOMEN RESULTS IN DECREASE CHEST WALL AND LUNG COMPLIANCE

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28
Q

obesity have what for their respiratory system

A

INCREASE IN OVERALL BLOOD VOLUME AND PULMONARY BLOOD VOLUME

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29
Q

tell me about obesity and lung compliance and elastic resistance

A

INCREASED ELASTIC RESISTANCE AND DECREASE IN CHEST WALL COMPLIANCE ARE FURTHER REDUCED WHEN SUPINE RESULTING IN SHALLOW AND RAPID BREATHING AND LIMITED MAXIMUM VENTILATORY CAPACITY. RESPIRATORY MUSCLES EFFICIENCY ARE BELOW NORMAL

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30
Q

what is the most commonly reported abnormalities of pulmonary function in obese patients

A

decrease in FRC and ERV

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31
Q

what is the decreased FRC, VC and total lung capacity result of

A

reduced expiratory reserve volume

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32
Q

what is the relationship between FRC and closing capacity (volume at which small airways begin to close)

A

volume at which small airways begin to close is adversely affected

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33
Q

what occurs with 02 consumption and co2 even at rest

A

obesity increases 02 consumption and co2 production even at rest

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34
Q

anesthesia and supine position decreases FRC up to what percent in obesity compared to what percent in non obese patients

A

50% obese

20% non obese

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35
Q

reduced FRC

A

REDUCED FRC (DUE TO DECREASE ERV) CAN RESULT IN LUNG VOLUMES BELOW CLOSING CAPACITY IN THE COURSE OF NORMAL TIDAL VENTILATION, LEADING TO SMALL AIRWAY CLOSURE, VENTILATION-PERFUSION MISMATCH, RIGHT TO LEFT SHUNTING AND ARTERIAL HYPOXEMIA.

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36
Q

OSA is more likely to be cause by what

A

excessive soft tissue

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37
Q

PHYSIOLOGICAL ABNORMALITIES R/T OSA

A

HYPOXEMIA, HYPERCAPNEA
PULMONARY HPTN, SYSTEMIC VASOCONSTRICTION
SECONDARY POLYCYTHEMIA FROM RECURRENT HYPOXEMIA
INCREASED RISK OF ISCHEMIC HEART DISEASE
CEREBROVASCULAR DISEASE
RV FAILURE D/T HYPOXIC PULMONARY VASOCONSTRICTION

38
Q

Gold standard diagnostic test for OSA

A

polysomnography (OPS)/sleep study

39
Q

what can we consider pre-op for severe OSA

A

CPAP

40
Q

what does obesity hypoventilation syndrome or pickwickian syndrome result from

A

long term OSA- seen in 5-10% of morbid obese

41
Q

what medical conditions result from OHS, Obesity, hypoventilation

A

pulmonary HTN, Cor pulmonale, alteration in function and structure of the RV

42
Q

where is an obese patient is the extra blood volume distributed

A

distributed in the fat.

43
Q

what does cardiac output do with obesity

A

cardiac output will be increased

44
Q

why does cardiac output increase and by as much as how what

A

increasing weight will increase as much as 20-30ml/kg of excess body fat b/c of ventricular dilation and increases in sv

45
Q

increased blood volume in obese patients

non obese patient

A

70ml/kg

50ml/kg

46
Q

what happens with increased LV wall stress

A

leads to hypertrophy, reduced compliance and impairment of LV filling (diastolic dysfunction) with elevated lvdp and pulmonary edema

47
Q

every 10kg of weight gain increase bp sys and dia by what

A

3-4mmhg increase systolic

2mmhg increase diastolic

48
Q

how does the renin angiotensin system play a role in obesity

A

increased circulating levels of antiotensinogen, aldosterone, and angiotensin- converting enzyme

49
Q

5% decrease in weight leads to reduce in what?

A

Sifnigicant reduction in renin antiotensinogen system

50
Q

Gi system and obestiy

A

gastric volume and acidity are increase

51
Q

GI system and liver function

A

liver function is altered and drug metabolism is adversely affected

52
Q

NPO can still have how much gastric fluid in stomach

A

> 25cc gastric fluid

53
Q

what does regurgitation of acidic stomach contents leads to

A

pneumonitis

54
Q

75% larger stomach volume + increased risk fo hiatal hernia, GERD, delayed gastric emptying, higher acidity, increased and pressure results in increase risk of ?

A

aspiration and pneumonitis

55
Q

unpremediacted, non diabetic fasting obese surgical patients who are free from significant GI pathology are unlikely to have what

A

high volumes low PH gastric contents after routine prep fasting

56
Q

obese /non obese- do they follow the same NPO guidelines

A

same NPO guidelines

57
Q

Sevo and obese pateitns

A

sevo hides in the fat

58
Q

when are we careful with des and obese patients

A

transient tachycardia

59
Q

abnormalities of the liver associated with obesity include

A

FATTY INFILTRATION, HIGH PREVALENCE OF NONALCOHOLIC FATTY LIVER DISEASE OR NAFLD. NONALCOHOLIC STEATOHEPATITIS OR NASH, FOCAL NECROSIS, AND CIRRHOSIS.

60
Q

issues with DM

A

wound healing, MI

61
Q

25% of obese patients have which disorder

A

potential subclinical hypothyroidism

62
Q

TSH level frequently elevated suggesting the possibility that obesity leas

A

to a taste of thyroid hormone resistance in peripheral tissues

63
Q

type II Dm related resistance of what

A

peripheral adipose tissue to insulin.

64
Q

regional is being used more frequently what are the advantages of it

A

decrease use of opioids , minimal or reduced manipulation of the airway administration of fewer meds with cardiopulmonary depression, decrease nausea and vomiting postoperatively, better post op pain control imposed post op outcomes

65
Q

higher rate of block failure

A

technical difficulties landmarks

66
Q

SIGNIFICANT KEY FACTORS IN LAW SUITS:

A

SUBOPTIMUM MONITORING OF PULSE OX, ETCO2 OR BOTH.

67
Q

MAC- monitoring oxygen is important due to

A

high risk of respiratory depression

68
Q

MAC use

A

opioids, benzo propofol cautiously and monitor co2 and sat

69
Q

what is peep used for

A

it is the only parameter that has consistently been shown to improve respiratory function in obese subjects

70
Q

further increase VT only increases the peak inspiratory airway pressure, end expiratory airway pressure and lung compliance without significantly improving arterial oxygenation

A

vt

71
Q

what should vt be maintained at

A

6 - 8 mL/kg PWB TIDAL VOLUME SINCE HIGHER TIDAL VOLUMES OFFER NO ADDED ADVANTAGES DURING MECHANICAL VENTILATION OF ANESTHETIZED MORBIDLY OBESE PATIENTS

72
Q

does obesity imply lung growth

A

no

73
Q

obese patients are more likely to be exposed to higher volumes due to

A

miscalculations of PBW or IBW

74
Q

mechanical ventilation exposed to higher airway pressures dt decreased respiratory system

A

compliance

75
Q

why is bleeding increase in the obese patient

A

dt difficulty accessing surgical site larger incisions extensive dissection

76
Q

AVOID RAPID INFUSION OF IVF D/T PRE-EXISTING CHF

A

AND THE KNOWLEDGE CHF DIAGNOSED OR UNDIAGNOSED CAN BE AN ISSUE WITH OBESE. THE USE OF IBW ESTIMATES AND APPROPRIATE MONITORING CAN HELP AVOID HYPERHYDRATION

77
Q

DEXMEDETOMIDIN

A

ALPHA-2 AGONIST WITH SEDATION AND ANALGESIC PROPERTIES, HAS NO SIGNIFICANT ADVERSE EFFECT ON RESPIRATIONS. IT CAN REDUCE POST OP OPIOID ANALGESIC REQUIREMENTS

78
Q

using peep during induction will do what

A

combat peri induction hypoxemia

79
Q

HYPOTHYROIDISM ASSOCIATED WITH

A

HYPOTHYROIDISM ASSOCIATED WITH HYPOGLYCEMIA, HYPONATREMIA, AND IMPAIRED HEPATIC DRUG METABOLISM

80
Q

OBESITY ASSOCIATED WITH GLOMERULAR HYPERFILTRATION .

A

EXCESSIVE WEIGH GAIN INCREASES RENAL TUBULAR REABSORPTION AND IMPAIRS NATRIURESIS THROUGH ACTIVATION OF THE SYMPATHETIC AND RENIN-ANGIOTENSIN SYSTEMS AS WELL AS PHYSICAL COMPRESSION

81
Q

ORLISTAT (OTC ALLI RX XENICAL)

A

ORLISTAT (OTC ALLI RX XENICAL): BLOCKS ABSORPTION OF DIETARY FAT. IMPROVES OF BP, FASTING BLOOD SUGAR, AND LIPID PROFILES.
ORLISTAT: CHRONIC USE: FAT-SOLUBLE VITAMIN DEFICIENCY. PROLONGED PROTHROMBIN TIME WITH A NORMAL PTT MAY REFLECT VITAMIN K DEFICIENCY. SHOULD BE CORRECTED 6-24 HOURS BEFORE ELECTIVE SURGERY

82
Q

be mindful of other drugs patient may be using for weight loss such as

A

herbs- look them up

83
Q

what is the most effective treatment for morbid obesity class 3

A

bariatric surgery

84
Q

malaabsorptive: jejunoileal bypass and biliopancreatic diversion - are these used today

A

rarely

85
Q

restrictive vertical band- gastroplasty and adjustable gastric banding

A

used today

86
Q

combined procedures

A

roux-en-y gastric bypass combines gastric restriction iwht a minimal degree of malaabsorption

87
Q

less invasive technique implantable gastric stimulator

A

placed by lap stops peristalsis to make patient feel full has issues

88
Q

most effective bariatric procedure

A

RYGB IS MOST EFFECTIVE BARIATRIC PROCEDURE TO PRODUCE SAFE SHORT AND LONG TERM WEIGHT LOSS IN SEVERELY OBESE PATIENTS.

89
Q

what is associated with less post op pain, lower morbidity, faster recovery and less third spacing of fluid

A

LAP BARIATRIC SURGERY IS ASSOCIATED WITH LESS POSTOP PAIN, LOWER MORBIDITY, FASTER RECOVERY, AND LESS “THIRD-SPACING” OF FLUID

90
Q

What is the only parameter that has consistently been shown to improve respiratory function in obese subjects?

A

PEEP

Spring '20/ L. BASICS- Immune, OR Hazards, OP (18 decks)

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