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Clinical assessment > Bariatric > Flashcards

Bariatric Flashcards

1
Q

Overweight BMI

A

25-29.9

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2
Q

BMI forumula

A

weight (kg)/height (m^2)

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3
Q

Ideal body weight formula

A

2.54 cm per inch

height in cm - 100 (men)

height in cm - 105 (women)

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4
Q

Men IBW formula

A

Height (cm) - 100

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5
Q

Women IBW formula

A

Height (cm)-105

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6
Q

Calculate the BMI of 440 lb pt that is 5ft 2 inches

A

81 bmi

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7
Q

hyperinsulinemia pathophys r/t HTN

A

activates SNS–>Na+ retention–>50-60% increase in incidence of HTN

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8
Q

obesity increases risk of HTN by

A

50-60%

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9
Q

Closing capacity formula

A

closing volume + residual volume

relationship at which small airways begin to close

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10
Q

closing volume is

A

the amount of air in the lungs at which the flow from lower sections of the lungs becomes severely reduced or halts

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11
Q

FRC

A

reduced due to decreased ERV (FRC = RV +ERV)

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12
Q

ERV

A

reduced

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13
Q

vital capacity

A

decreased

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14
Q

total lung capacity

A

decreased

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15
Q

Decreased FRC is related to

A

the relationship at which small airways begin to close

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16
Q

Most sensitive indicator of the effect of obesity on pulmonary function

A

ERV

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17
Q

GA causes FRC to fall by (obesity)

A

50%

(20% normally)

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18
Q

chronic hypoxemia can lead to (3)

A

polycythemia
pulmonary HTN
Core pulmanole

19
Q

Obesity hypoventilation syndrome aka

A

pickwickian

20
Q

pickwickian/OHS and resp depressant effeects of anesthesia

A

increase

21
Q

RV failure can occur from

A

hypoxic pulmonary vasoconstriction

22
Q

Hypopnea

A

50% reduction in airflow with 4% fall in SaO2–>requires sleep study

23
Q

Gold standard for OSA diagnosis

A

Overnight polysomnography (OPS)

24
Q

Clues to OSA (3)

A
  1. BMI >35
  2. neck circumfrence >16

hyperinsulinemia
elevated glycosylated hemoglobin

25
Q

STOP BANG

A

Snoring
Tiredness
Observed stop breathing
Pressure

BMI >35
Age
Neck circum >40
Gender male

> 3 questions yes = high risk for OSA

26
Q

hypertrophy in obesity

A

Eccentric

27
Q

ECG changes

A

-.Low QRS voltage
-LVH criteria
-left atrial enlargement
-t wave flattening inferior and lateral leads
-prolonged QT interval

28
Q

Portal triad clamping - mechanism and why

A

TO reduce blood loss

hepatic artery
portal vein
Common bile duct

29
Q

WIth previou bariatric surgery, what happens with mebranes

A

premature rupture of membranes (pregnancy)

30
Q

Lean body weight on induction

A

Propofol
Roc
Vec
Remifent

31
Q

Lean body weight maintancance

A

Roc
Vec
Remifent
Sufent
fent

32
Q

total body water obesity

A

decreased

33
Q

IV drug delivery obesity

A

higher CO–>shorter drug circulation time and faster delivery to site of action

34
Q

good predictors of difficult intubation

A

BMI with Mallampati >3 with a large neck circumference* and history OSA

35
Q

Cricoid pressure position

A

Below thyroid cartiladge, above cricoid cartiladge

36
Q

FiO2

A

preoxygenate 100% for 3-5 min

intraop: 50%-80%

37
Q

PEEP

A

10-12

38
Q

TV

A

6-8 mL/kg iBW

39
Q

PaCO2 intraop

A

40-45 (permissive hypercapnia OK)

40
Q

only parameter that has consistently shown improved rspiraty funciton is

A

PEEP! up to 10 cm H2O

41
Q

Fluids should be calculated by

A

lean body weight

ideal body weight x 1.3

42
Q

Least invasive bariatric procedsure

A

restrictive (laprascopic sleeve gastrectomy or gastric. band)

43
Q

Most common cause of surgical related mortality in obese patients

A

Anastomotic leak

44
Q

Top 3 symptoms of anastomotic leak

A
  1. tachycardia
  2. fever
  3. abdominal/pelvic pain

also SOB, restlessness, L soulder pain, increased thirst, hypotension

Clinical assessment (10 decks)

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