Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Special Pop Exam 1 > Barash 34: Elderly & Obese > Flashcards

Barash 34: Elderly & Obese Flashcards

1
Q

What makes old ppl frail?

A

aging process affects connective tissue and cellular function, including the mitochondria, and inevitably leads to decreased function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

T/F:
The rate at which diminished function and frailty develop is highly variable

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why do old people have increased sensitivity to anesthestic agents?

A

Decreased organ reserve from body composition changes:
* connective tissue stiffening
* decreased muscle mass
* impaired autonomic reflexes
* increased sensitivity to drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

increased likelihood of instability of these 3 systems

A

hemodynamic, pulmonary, and thermoregulatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to dose prop for eldery

A

20–60% reduction
dose on lean body mass
1 mg/kg in very old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Obese patients may appear asymptomatic even when they have significant cardiovascular disease because …

A

they often have limited exercise tolerance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

single best predictor of problematic intubation in morbidly obese patients

A

Neck circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

larger neck circumference is associated with

A
  • male
  • higher Mallampati score
  • grade 3 laryngoscopic views
  • OSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T/F:
Elevated liver function tests (mostly elevated alanine aminotransferase) are seen in many obese patients, which signifies decreased liver metabolism.

A

False
but no clear correlation exists between abnormalities of routine liver function tests and the capacity of the liver to metabolize drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Morbid obesity is a major independent risk factor for
(2)

A

deep venous thrombosis
and sudden death from acute postoperative pulmonary embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

critically important in the prevention of postoperative complications for obese pts

A

early mobilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

_____ is the only ventilatory parameter that has consistently been shown to improve respiratory function in obese patients, but it….

A

PEEP

decreases venous return, cardiac output, and subsequent oxygen delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in obese patients, forearm measurements with a standard cuff

A

may overestimate both systolic and diastolic blood pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

head-elevated laryngoscopy position

A

elevates the obese patient’s head, upper body, and shoulders above the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

do obese patients need smaller or larger induction doses?
why?

A

Larger

blood volume, muscle mass, and cardiac output increase linearly with the degree of obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do obese pts need more suxx?

A

increase in pseudocholinesterase activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which 3 factors r/t drug dosing increase linearly with the degree of obesity?

A

blood volume, muscle mass, and cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

reduces the likelihood that the morbidly obese patient will become ventilator-dependent

A

Prompt but safe extubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do opioid-sparing multimodal analgesic techniques for obese?

A

risk of perioperative hypoxemia and apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

table 45-1
Classification of Obesity
and Systemic Disease Risk
According to Waist Circumference

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F:
Waist circumference is an independent risk predictor of disease

A

True

correlates with abdominal fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Visceral fat is particularly associated with

A

CV disease & LV dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bariatric surgery is currently the most effective treatment for which class of obesity?

A

morbid (class III) obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bariatric procedures by type

A

malabsorptive (jejunoileal bypass & biliopancreatic diversion, biliopancreatic diversion with duodenal switch)

restrictive (vertical-banded gastroplasty, adjustable gastric banding, sleeve gastrectomy)

combined (Roux-en-Y gastric bypass [RYGB])

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

restrictive bariatric surgery

A

vertical-banded gastroplasty
adjustable gastric banding
sleeve gastrectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which bariatric surgery is no longer performed?
why?

A

jejunoileal bypass

risk for revisions and adverse health effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Table 45-2 Implications of Medical Consequences of Obesity

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Decreased lung compliance is partially explained by

A

increased pulmonary blood volume because of an overall increase in blood volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Decreased pulmonary compliance leads to

A

decreased
FRC, vital capacity, & total lung capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Reduced FRC effects

A
  • lung volumes below closing capacity in the course of normal tidal ventilation = small airway closure
  • ventilation–perfusion mismatch
  • right-to-left shunting
  • arterial hypoxemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which lung parameter is usually normal in obese?

A

Forced expiratory volume in 1 second
forced vital capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Anesthesia in supine
how it affects FRC
obese vs nonobese

A

obese: ↓ 50%
nonobese: ↓ 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

T/F:
Obesity increases oxygen consumption and carbon dioxide production even at rest.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Obese pts have (decreased/increased) alveolar ventilation.

A

increased

body attempts to meet increased metabolic demands by increasing both cardiac output and alveolar ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

T/F:
most obese patients retain their normal response to hypoxemia and hypercapnia

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Chronic hypoxemia may lead to

A

polycythemia, pulmonary hypertension, and cor pulmonale.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

In obese patients, sleep apnea is more likely to result from

A

airway obstruction produced by excess soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Physiologic abnormalities resulting from OSA

A

hypoxemia, hypercapnia
pulmonary hypertension
systemic vasoconstriction, hypertension
secondary polycythemia (recurrent hypoxemia)
⬇️
increased risk of ischemic heart & cerebrovascular disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

The gold standard technique for diagnosing OSA

A

overnight polysomnography (OPS)

pero the inconvenience, time, and expense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

signs of OSA

A
  • witnessed episodes of apnea during sleep
  • BMI 35 or more
  • neck circumference 16+ in (women); 17+ in (men)
  • hyperinsulinemia
  • elevated glycosylated hemoglobin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

OSA
common but not predictive features

A
  • snoring
  • frequent arousals during sleep
  • daytime sleepiness
  • impaired concentration/memory
  • morning headaches

okay but this is me

42
Q

(Pickwickian) syndrome (OHS) is a combination of

A

obesity and chronic hypoventilation

43
Q

(Pickwickian) syndrome (OHS) may result in

A

pulmonary hypertension & cor pulmonale
increased risk of postop complications
death

44
Q

how does OSa affect respiratory drive?

A

alters the control of breathing
CNS-mediated apneic events

increases reliance on hypoxic drive for ventilation

45
Q

Total blood volume in obese

A

increased
but
on a volume-to-weight basis, it is less than in nonobese individuals
(50 mL/kg compared with 70 mL/kg)

46
Q

Blood flow to fat

A

2 to 3 mL/100 g

47
Q

why does excess fat require increased cardiac output?

A

increased oxygen consumption

leads to a systemic arteriovenous oxygen difference that remains normal or slightly above normal

48
Q

Why are Cardiac dysrhythmias more common in obese?

A
  • fatty infiltration of the conduction system
  • hypoxia, hypercapnia
  • electrolyte imbalance
  • coronary artery disease
  • increased circulating catecholamines
  • OSA, and myocardial hypertrophy
49
Q

T/F:
Cardiac output rises faster in response to exercise in the morbidly obese

A

True

50
Q

Obese patients have normal-to-increased levels of sympathetic nervous system activity which causes….

A

insulin resistance, dyslipidemia, and hypertension

51
Q

these obesity-induced comorbidities are responsible for the increased cardiovascular risk in obese patients

A

normal-to-increased levels of sympathetic nervous system activity, which predispose to insulin resistance, dyslipidemia, and hypertension

52
Q

Metabolic Syndrome
“syndrome X”
“insulin resistance syndrome”

A

3 of these 5
(1) Central obesity: Waist circumference 102 cm or more (≥40 in) in males, 88 cm or more (≥35 in) in females
(2) Dyslipidemia: Triglycerides 150+ mg/dL
(3) Dyslipidemia: HDL 40 mg/dL or less in males, 50 mg/dL or less in females
(4) Hypertension: 130/85+ or on BP meds
(5) Elevated fasting glucose: 100+ mg/dL or on hyperglycemic agent

53
Q

T/F:
Metabolic Syndrome is not linked to postop infection.

A

False
increases risk

54
Q

Table 45-3
IV Drug Dosing in Obesity
Induction & NMBs

A
55
Q

Table 45-3
IV Drug Dosing in Obesity
Opioids and reversal

A
56
Q

Dose on LBW vs TBW

A

LBW:
Propofol PUSH
Roc, Vec, Atra, Cisatra
Fenatanyls
thiopental

TBW:
Suxx
Propofol DRIP
Sugammadex, neostig
precedex

57
Q

How to dose benzos

A

Highly lipophilic drugs with larger VD
longer duration

Midazolam:

  • prolonged sedation; larger initial doses are required to achieve adequate serum concentrations
  • titrated in small doses in immediate preoperative period
58
Q

T/F:
Obesity is not an accepted risk factor for difficult mask ventilation and airway management.

A

False
it is!

59
Q

T/F:
The magnitude of BMI does not significantly influence the difficulty of laryngoscopy.

A

True
Overall, it does not

affects mask ventilation and airway management more

60
Q

T/F:
Pickickian patients have more difficult airway management.

A

True

61
Q

helps keep obese pts from falling off the operating room table

A

Strapping to the table in combination with a malleable beanbag

62
Q

How to size BP cuff

A

bladder encircles 75% of the upper arm circumference or, preferably, the entire arm

63
Q

Your pt is so obese that a BP cuff cannot be sized. Wyd?

A

A-line

64
Q

T/F:
going from sitting to supine position can cause a significant increase in oxygen consumption and cardiac output in obese pts

A

True

65
Q

Which position provides the longest safe apnea period during induction of anesthesia for obese?

A

head up

66
Q

favored over prone positioning whenever the surgical procedure permits

A

Lateral decubitus

67
Q

most common mononeuropathy after bariatric surgery

A

carpall tunnel syndrome

less common:
encephalopathy (Wernicke), optic neuropathy, and myelopathy associated with vitamin B12 and copper deficiencie

68
Q

100% oxygen
pros and cons

A

pros: extends the nonhypoxic apnea period after induction

cons: increases atelectasis

69
Q

The head-up position

A

reverse Trendelenburg or semi-sitting positions

70
Q

T/F:
You canse use NIPPV in preop or CPAP during induction to delay peri-induction hypoxemia

A

True

71
Q

Which gives you a better view?
“ramped” or “sniffing” position?

A

ramp

72
Q

Ramping position
“stacking”

A
  • Towels or folded blankets under the shoulders and head
  • compensates exaggerated flexed position from posterior cervical fat
  • tip of the chin higher than the chest
73
Q

T/F:
No systematic comparison of anesthetic agents or techniques is available in obese patients

A

True

74
Q

Pneumoperitoneum should not be increased above

A

15 mmHg!

20 mmHg or greater can cause caval compression and decrease cardiac output.

75
Q

Why do obese pts have higher EBL?

A

difficulties accessing the surgical site = larger incisions and more extensive dissection

76
Q

Why is luid management is particularly challenging in the obese patient?

A

intravenous fluid requirements are generally greater than predicted

77
Q

Rapid infusion of intravenous fluids in obese

A

avoided because pre-existing congestive cardiac failure is common

78
Q

T/F:
urine output does not correlate with the rate of intraoperative fluid administration

A

True

79
Q

tidal volumes recommended for obese patients

A

6 to 8 mL/kg PBW

Predicted body weight (PBW) and ideal body weight (IBW) are the same thing

80
Q

Further increasing tidal volumes will only….

A

increase peak inspiratory and plateau pressure
without significantly improving arterial oxygen tension

81
Q

recruitment maneuvers

A

3 short (6 seconds) inflations with PCV to administer a large tidal volume by reaching an inspiratory pressure of 40 to 55 cmH2O

82
Q

Obesity
Some experts recommend the FiO2 to be kept….

A

lower than 0.8

83
Q

Positioning for extubation & recovery

A

extubated semirecumbent
recovered sitting position

84
Q

Why give sedation judiciously to obese?

A

higher risk of sedation-induced respiratory depression

85
Q

Benefits of NA anesthesia for obese

A

(1) Minimal/reduced manipulation of the airway
(2) give less meds with cardiopulmonary depression
(3) reduced risk PONV
(4) better postop pain control
(5) improved postop outcomes

86
Q

Obesity
Physiologic changes associated with neuraxial anesthesia.

A
  • supine and Trendelenburg = airway collapse
  • false losses of resistance due to fat deposition
  • ultrasound limitations; image quality can be compromised due to fat overlying the epidural space
87
Q

When is it okay to do spinal on obese

A

normal airway
no cardiopulmonary disease
surgery <90 minutes.

88
Q

Obese pts have (less/more) CSF.

A

less

effective dose of spinal local anesthetic is reduced

89
Q

Postoperative CPAP may improve oxygenation, but does not …

A

facilitate CO2 elimination

90
Q

T/F:
NIPPV increases the incidence of major anastomotic leakage after gastric bypass surgery

A

False
theoretical risk but not proven

91
Q

Why use an abdominal binder in obese?

A

avoid postoperative hypoventilation and atelectasis

92
Q

T/F:
Opioids increase the risk of central apnea in ALL patients.

A

True

93
Q

T/F
Routine admission to ICU/high acuity care units has not been shown to reduce the risk of pulmonary complications or change perioperative outcome in obese pts.

A

True

94
Q

T/F:
BMI alone does not increase the risk for perioperative complications or unexpected admission after ambulatory surgery.

A

True

keywords: after ambulatory surgery

95
Q

T/F:
The maximum 400 J of energy on regular defibrillators is usually sufficient for morbidly obese patients but anticipate more attempts.

A

True

their chest wall is usually not much thicker, but the higher transthoracic impedance from the fat may require a greater number of attempts

96
Q

Obesity
most common postoperative complications

A
  • respiratory (atelectasis, pneumonia)
  • vascular (thrombophlebitis, DVT)
  • wound complications (infection, dehiscence)
97
Q

T/F
Obesity increases postop morbidity, but not necessarily mortality.

A

True
Postoperative morbidity is increased in obese patients, but increased mortality is controversial

98
Q

T/F:
Periop adverse events in obese pts is most strongly correlated with BMI.

A

False
strongly associated with pre-existing disease more so than BMI alone

99
Q

T/F:
A patient with previously diagnosed metabolic syndrome has significantly greater risk of perioperative morbidity and mortality than an obese patient with no metabolic syndrome features.

A

True

100
Q

Obesity increases the risk of surgical site infections by…

A
  • hyperglycemia/diabetes
  • longer surgical procedures
  • hypoperfusion or low tissue oxygen tension
  • low tissue antibiotic concentration

Special Pop Exam 1 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions