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6901 > Gerontology & Obesity > Flashcards

Gerontology & Obesity Flashcards

1
Q

Decreased Propofol requirements for general anesthesia in the elderly

A

Propofol dose 15% lower in elderly vs young adults

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2
Q

MAC decrease per decade

A

6%

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3
Q

Cardiovascular changes in the elderly

A

HTN: loss of vascular elasticity
Difficulty increasing cardiac output: Reduced efficacy of beta agonists, endogenous physiological beta blocker, diminished baroreceptor responses
Prolonged circulation time
*Accelerates induction of inhalation agents but decreases onset for IV induction
*Baroreceptor responses respond to vascular tone (increase/decrease HR/BP)

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4
Q

Pulmonary changes in the elderly

A

Elastin isn’t replaced by collagen

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5
Q

Ideal body weight

A

AKA Broca’s index
-Lowest morbidity and mortality for a given population
= height (cm) - men(100) or women(105)

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6
Q

Converting inches to centimeters

A

In x 2.54 = cm

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7
Q

Lean body weight

A

TBW - adipose tissue
=IBW x 1.3
-Doesn’t work for nonobese people (TBW=IBW)

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8
Q

BMI cutoff for obesity and overweight

A

> 30 obese

>25 overweight (often inaccurate for muscular individuals)

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9
Q

CV system and obesity (and EBV calculation for obese)

A

CO increases 0.1L/min for every kg fat gain (d/t increased O2 consumption)
-HR constant, achieved by increased SV
-Greater demand on myocardium -> LV hypertrophy
-Increased total blood volume
EBV=45-50mL/kg (instead of 70)

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10
Q

Obese non-hypertensive heart adaptation to obesity/HTN

A

Decrease SVR

Increased blood volume -> eccentric dilated heart

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11
Q

Obese and uncontrolled HTN heart adaptation to obesity/HTN

A

Increased blood volume
Mixed eccentric/dilated and concentric/ventricular hypertrophy (wall thickening)
-Will lead to heart failure and pulmonary hypertension
*Wall thickening plus increased blood volume

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12
Q

Obesity increased risk of hypercoagulability

A 
Increased clotting factors
-Fibrinogen
-Factor VII
-Factor VIII
-vWF
-Plasminogen activator factor
Predisposes to fibrin clot formation
3x risk of developing CAD for every unit change in BMI 
-Obese 50% increased risk of DVT vs nonobese
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13
Q

Thromboembolic disorders in obese patients

A

Increased risk of CVA or PE

-Related to prothrombotic and chronic inflammatory state because of excess adipose tissue accumulation

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14
Q

O2/CO2 changes in obese

A

Increased O2 consumption and CO2 production

-Maintain normocapnia by increasing MV (rapid shallow breathing) - uses the least amount of energy

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15
Q

Obesity effect on ERV

A

Expiratory reserve volume

  • Decreased
  • Most sensitive indicator of pulmonary function in obese individuals
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16
Q

OSA/Hypopnea syndrome in obese patients

A 
Apnea
-Reduction in airflow >10 seconds
->15 episodes/hr of sleep
-Decreased SaO2 >4%
Test
-OPS: Overnight polysomnography
-Inconvenient, a majority of patients are undiagnosed
17
Q

3 types of sleep apnea

A

OSA
-Periodic/partial/complete obstruction
-Respiratory efforts but no airflow, produced by excess soft tissue
Central sleep apnea
-No respiratory efforts
Mixed
-Attributes of both OSA/central sleep apnea
-Delayed effort with varying degrees of obstruction
*All associated with decreased O2 levels

18
Q

STOP Bang

A 
Screening tool for OSA
-Sensitivity of 93%
Snoring
Tiredness
Observed stop breathing
Blood Pressure
BMI>35
Age>50
Neck circumference>40cm
Gender male
High risk = 3+ items
-Refer for sleep testing
19
Q

Nonalcoholic fatty liver disease (NAFLD)

A

Increased adipose tissue -> increased intrahepatic triglycerides, impaired insulin activity, release of inflammatory cytokines
-Destruction of hepatocytes and cirrhosis
-Elevated ALT
-Benign form of hepatitis but can lead to HCC, portal HTN
Mortality from liver disease is 1.5-2.5 higher than nonobese

20
Q

Endocrine/Metabolic disease and obesity

A

Pancreas: infiltrated with fat -> decreased insulin secretion
Adipocytes: enlarged -> insulin resistance
Abnormal glucose tolerance, hyperglycemia, insulin resistance -> increased wound infection, silent MI
Surgical stress -> adrenal release cortisol -> increased need for insulin
Subclinical hypothyroidism in 25% morbidly obese -> increased TSH levels and possibly TH resistance in tissues

21
Q

Too small of a BP cuff ___estimates the BP

A

Overestimates

22
Q

Pharmacology for obese patients

A

Water soluble meds based on IBW
Lipid soluble meds based on TBW
Lipophillic drugs have increased volume of distribution (elimination half life is prolonged)
-Benzos and barbiturates : Don’t redose!

23
Q

Muscle relaxant dosing in obese

A

Nondepolarizing: Based on IBW (or even lean body weight)
Succinylcholine: Based on TBW (pseudocholinesterase activity is increased in obesity)

24
Q

Opioid use in obesity

A

Initial dose is the same but repeat doses are less predictable

25
Q

Volatile anesthetics in obesity

A

Sevo/Des: More water soluble, less emergence time

Iso: More lipid soluble, accumulates, increased emergence times

26
Q

Propofol in obesity

A

Highly lipophilic, accumulate if TIVA is used

  • Induction dose based on LBW
  • Maintenance dose based on TBW, decrease with increased time to avoid accumulating
27
Q

Volume replacement in obesity

A

Normally Total body water=60%
In obesity=40%
Estimated blood volume=45-55mL/kg of actual body weight
Avoid rapid infusion of IVF -> CHF

28
Q

Extubation in obesity

A 
Depends on 
-How easy to BMV
-How easy to intubate
-Length/type of surgery
-Plus all normal considerations
If doubtful, leave ETT in place
29
Q

Post op respiratory complications and obesity

A

Respiratory failure is the most common major postop complication

30
Q

Post op cardiovascular complications and obesity

A

Increased 30 day morbidity due to MI
-Normal population: 0.1%
-Obese: 0.5%
Also higher incidence of a fib

31
Q

DVT/PE in obesity

A

PE is leading cause of mortality post-op in obese patients

-50% higher rates in obese patients

32
Q

Restrictive bariatric surgery

A

Goal=limit food intake
VBG: vertical banded gastroplasty (not done anymore)
AGB: Laparoscopic adjustable gastric banding
-Removable
-Shorter hospital stay
LSG: Laparoscopic sleeve gastrectomy
-Resection of stomach to 20% original size

33
Q

Combined restrictive/mildly malabsorptive obesity surgery

A

RYGB: Roux-en-Y gastric bypass

  • Laparoscopic
  • Most effective bariatric procedure
  • Small pouch limits food intake
  • Distal resected end anastomosed to ilium: small intestinal limb
34
Q

Combined mildly restrictive/largely malabsorptive obesity surgery

A

BPD with DS: Biliopancreatic diversion with duodenal switch

  • Hemigastrectomy to make gastric pouch, connects directly to ilium
  • Typically done with “super-obese”
35
Q

Obesity surgery mortality risk score

A 
1 point for each:
-BMI>50
-Male
-Hypertension
-High risk for DVT
-Age>45
0-1=Low risk (0.2%)
2-3=Intermediate risk (1.3%)
4-5=High risk (2.4%)

6901 (9 decks)

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