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Principles II N517 > Anesthetic Considerations for Obesity and Surgery > Flashcards

Anesthetic Considerations for Obesity and Surgery Flashcards

1
Q

What diseases are obese people at risk for?

A 
CAD
HTN
CA
Cerebrovascular dx
Hyperlipidemia
DM
Gall bladder dx
DJD
OSA
OHS
Socioeconomic and psychological impairment
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2
Q

What BMI is low-risk for developing 1 or more comorbidity?

A

25-30 kg/m2

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3
Q

What BMI is high-risk for developing 1 or more comorbidity?

A

> 40 kg/m2

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4
Q

What is a major factor in anesthesia we consider with obesity?

A

difficult airway management

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5
Q

Majority of extubation or recovery claims were associated with _________, obesity, and/or ______.

A

difficult intubation on induction, OSA

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6
Q

What is Broca’s index?

A

most practical way to figure IBW

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7
Q

How can you calculate IBW for a male?

A

ht (cm) - 100

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8
Q

How can you calculate IBW for a female?

A

ht (cm) - 105

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9
Q

What are the NIH grades of obesity?

A

Grade I: BMI 26-29 kg/m2
Grade II: BMI 30-30.9 kg/m2
Grade III: BMI >40 kg/m2

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10
Q

What are the classifications of obesity?

A 
Normal: 24-26 kg/m2
Mild: 27-30 kg/m2
Moderate: 31-35 kg/m2
Severe/morbid: >35 kg/m2
Super morbid: >55 kg/m2
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11
Q

What are some psychological impacts of obesity?

A

low self-esteen
distorted self image
depression
discrimination from public and healthcare providers
perpetuation of obesity from all the above

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12
Q

What are some characteristics of central/android/abdominal/”apple”?

A
  • “at risk” waist/hip ratio: male>0.95, female >0.80
  • > myocardial fat content
  • increased incidence of ischemic CV disease, cerebrovascular disease, NIDDM, certain cancers, and death
  • risks independent of total adipose mass
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13
Q

What are some characteristics of peripheral/gynecoid/gluteal femoral/”pear”?

A
  • waist/hip ratio
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14
Q

With which gender is android fat distribution more common?

A

male

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15
Q

What does it mean when fat is metabolically active with regard to free fatty acid release (FFA)?

A

With high FFA levels delivered to liver, get stimulation of hepatic synthesis of very-low density lipoproteins (VLDL) and increased circulation of low density lipoproteins (LDL); hepatic exposure to high FFA levels causes glyconeogenesis and inhibition of insulin uptake causing NIDDM; increased myocardial fat content + decreased contractility correlates positively with higher waist-to-hip ratio and serum free fatty acid concentration

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16
Q

What are the myocardial changes with obese normotensive patients?

A

Increased preload = myocardial volume increases more than wall thickness (eccentric hypertrophy)

17
Q

What are the myocardial changes with obese hypertensive patients?

A

Increased preload and afterload with periods of hypoxemia = LV dilation and wall stress leading to both eccentric and concentric hypertrophic changes, but concentric >eccentric

18
Q

How much does your cardiac output increase per kg of body fat?

A

0.1 L/kg of body fat

19
Q

What are myocardial changes with a lean hypertensive patient?

A

increased afterload = increased wall thickness + diminished volume (concentric hypertrophy)

20
Q

What is the “bottom line” for obesity and cardiovascular diseasE?

A

obesity + hypoxia leads to heart disease and increased risk of sudden death

21
Q

What are some pulmonary complications of obesity?

A 
restrictive lung disease patterns
asthma
difficult airway
OSA
Pickwickian
22
Q

What is obesity-hypoventilation system?

A

worsening severe sleep apnea which leads to loss of hypercarbic drive, hypersomnolence, increased DAW

23
Q

What are the characteristics associated with Pickwickian syndrome?

A

hypercarbia, hypoxemia, polycythemia, hypersomnolence, pulmonary HTN, biventricular failure

24
Q

What is metabolic syndrome?

A

characterized by obesity, hypertension, and diabetes; increased risk of CAD and stroke

25
Q

What can pulmonary pathologies cause in obese patients/

A 
Increased metabolic demands
Increased work of breathing
Closure of small airways
VQ mismatch
Hypoxemia
26
Q

What are some GI pathologies common with obese patients?

A 
Metabolic syndrome
Cushing's disease
Hypothyroidism
Hiatal and inguinal hernia
Cholelithiasis
Irritable bowel syndrome
Hepatic steatosis
GERD
aspiration risk
high gastric volumes
Pituitary/gonadal dysfunction
Polycystic ovary disease
Amenorrhea
Infertility
Gout
Increased intraabdominal pressures
27
Q

What are genitourinary complications common with obesity?

A
  • stress incontinence
  • renal calculi
  • menstrual problems
  • increased renal clearance of drugs due to increased renal blood flow and increased GFR
28
Q

What are musculoskeletal problems common with obesity?

A
  • degenerative arthritis
  • back pain
  • immobility
  • stress fractures from bone demineralization
29
Q

What are common malignancies with obesity?

A
  • breast
  • prostate
  • colorectal
  • cervical/endometrial
  • ovarian
30
Q

What are common integumentary complications with obesity?

A
  • venous stasis of legs
  • cellulitis
  • diminished hygiene
  • intertrigo (reddened rash in folds of skin)
  • carbuncles (cluster of boils on back of neck or thigh)
  • acanthosis nigricans (dark, velvety skin in folds and creases)
31
Q

What are common neurological complications with obesity?

A
  • stroke
  • idiopathic intracranial hypertension (pseudotumor cerebri: s/s brain tumor without presence of tumor)
  • meralgia parasthetica (Burnhart’s syndrome: entrapment of femoral cutaneous nerve at inguinal ligament, get numbness and tingling)
32
Q

What should you specifically evaluate for during a preoperative assessment?

A
  • systemic HTN
  • pulmonary HTN (DOE, fatigue, syncope, echo showing TR, ECG showing RVH, CXR prominent pulmonary arteries)
  • right or left ventricular failure (PND, increased JVP, added heart sounds, rales, hepatomegaly, and peripheral edema)
  • ischemic heart disease
  • airway involvement (difficult airway potential)
  • medication usage (herbals and weight loss aid)
  • assess peripheral and central venous access
33
Q

What is included in OSA pretreatment?

A
  • sleep study (PSG) in selected patients
  • gender, waist-hip ratio, neck circumference
  • strongly consider preop CPAP if PSG dx moderate-severe OSA
  • smoking cessation at least 6 weeks with active support to improve compliance
34
Q

What can cause sudden death post-operatively in morbidly obese patients?

A

pulmonary embolism

35
Q

What are some thromboprophylaxis methods?

A
  • heparin 5000 units q12h
  • pneumatic compression stockings
  • LMWH
  • Other
36
Q

What are some intra-op considerations for obese patients?

A
  • OR table should be weight appropriate
  • have proper airway equipment in the room and be prepared if difficult intubation
  • routine use of >30 degree reverse T-berg during induction and emergence
  • consider CPAP 10 cm H2O during preO2 period
  • monitoring (invasive when needed, measurements increased if cuff too small)
37
Q

What should you include with your airway equipment for obese patients?

A

Fast Track LMA

Principles II N517 (7 decks)

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