Anesthesia implications for obesity Flashcards
Factors that influence obesity
Influenced by;
metabolic factors,
hormones,
neural regulation and
pathologic syndromes in addition to behavioral, cultural, and
socioeconomic factors
BMI equation
Patient weight (kg)/ height2 in meters = kg/m2
created by insurance companies to calculate risk
What does BMI not differentiate between
Overweight and overfat
Waist circumference, waist-hip ration, age
Android fat distribution
“central” obesity
Upper body (truncal)
Associated with ↑ oxygen consumption/cardiovascular dz
Gynecoid Fat distribution
“peripheral” obesity
Hips, buttocks, thighs
Less metabolically active
Not really associated with CV disease (genetics)
Total blood volume ____ in obesity
increases
On a volume-to-weight ratio is lower 50ml/kg
Most distributed to adipose tissue
CO is ____ in obesity because of ______
increased
d/t LV dilation and ↑ stroke volume
20-30ml/kg of excess body fat
Increase in cardiac dysrhythmias is due to____
d/t fatty infiltrates of conduction system, CAD,
EKG changes with obesity
Low QRS voltage; because of increased impedence,
LVH,
left axis
Hematologic changes with obesity
↑er levels of fibrinogen, factor VII, VIII, von Willebrand —-> Hypercoagulability
Endothelial dysfunction in obesity is due to_____
higher levels of factor VIII and von Willebrand
Gastric considerations for obesity
Gastric volume and acidity are increased -> Intragastric pressure increases -> Relaxation of LES and hiatal hernia formation (increased)
Delayed gastric emptying
Gastric levels and ph for risk of pneumonititis
Volume > 25 ml and pH < 2.5…levels for aspiration pneumonitis
Hepatic changes with obesity
Hepatic function/drug metabolism is altered
decreased albumin in circulation
RBF _____ with obesity
increases (Glomerular hyperfiltration)
will then have a drop off as the kidneys dont perfuse as well
Increased renal tubular reabsorption results in what? (2)
Impairs natriuresis
Activates renin-angiotensin system
Increased level of SNS activity in obesity results in what? (4)
Insulin resistance…impaired glucose metabolism
Enhanced pressor activity of norepi and angiotensin II
Sodium retention
Thyroid hormone resistance
Hypothyroidism prevalence in obesity
Hypothyroidism in 25% of morbidly obese patients
Metabolic syndrome (8)
*Abdominal obesity; (Uses waist circumference (not BMI))
*Decreases levels of HDL
*Hypertriglyceridemia
Hyperinsulinemia
*Glucose intolerance
*Hypertension
Proinflammatory state
Prothrombotic state
- at least 3 must be present for diagnosis
Risk factors for metabolic syndrome (3)
Increased age
Men > women
Hispanics and South Asians
Metabolic syndrome may result from ____, ____,_____,____
May result from chronic corticosteroids, antidepressants, antipsychotics, protease inhibitors
Metabolic syndrome results in increased risk of ________ (5)
Cardiovascular disease
Type 2 diabetes mellitus
Polycystic ovary syndrome
Nonalcoholic fatty liver disease
Improper immune responses
OSA dx (4)
Complete cessation of breathing
Lasting 10 seconds or >
5x or > each hour of sleep
Decreased sat 4%
Hypopnea dx (4)
Reduction in airflow 50% or >
Lasting 10 seconds or >
15 x or more/hour of sleep
Decreased sat 4%
name for Sleep study
polysomnography
apnea/hypopnea index (AHI)= total # of events/total sleep time
ranking for mild, moderate, severe
Mild: 5-15/hr
Moderate: 15-30/hr
Severe: > 30/hr
Treatment (CPAP, weight loss) required for mod/severe disease OSA d/t risk of (4)
Systemic/Pulmonary hypertension
LVH
Cardiac dysrhythmias
Cognitive impairment
Obesity hypoventilation syndrome other name
Pickwickian syndrome
Obesity hypoventilation syndrome results from _____
Results from long-term OSA…5-10% of morbidly obese
Obesity hypoventilation syndrome results in______(2)
Pulmonary hypertension
Cor pulmonale