Brainscape's Knowledge GenomeTM

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


See full index

AS - N931 Advanced Principles of Anesthesia > Obese Population > Flashcards

Obese Population Flashcards

1
Q

Overweight vs. Obesity

A

Overweight - increased body weight above standard r/t height BMI 25-30kg/m^2
Obesity - excessive body weight based on patient age, gender, & height (body weight >20% IBW) energy imbalance disorder >30kg/m^2

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

Ideal Body Weight

A

Height (cm)
Weight (in) x 2.5 = cm
Male - 100
Female - 105

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

Adjusted Body Weight

A

ABW

0.4 (TBW - IBW) + IBW

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

Lean Body Mass

A

LBM

IBW + 20%

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

Body Mass Index

A

BMI
Weight (kg) / Height m^2

BMI > 30kg/m^2 (obesity) associated w/ ↑morbidity r/t stroke, ischemic heart disease, HTN, & diabetes

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

Obesity Classes

A

1 BMI 30-35
2 BMI 35-40
3 BMI 40-50
Superobese BMI >50

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

Android Obesity

A

Abdominal (central) obesity
More common in men
Higher incidence metabolic disturbances
↑risk ischemic heart disease, stroke, diabetes, death

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

Gynecoid Obesity

A

Gynecoid fat distribution
Fat around hips & buttocks
More common in females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Disease Processes Associated w/ Obesity

A 
OSA or hypoventilation syndrome
Restrictive lung disease
HTN/CAD
Hyperlipidemia
GERD or delayed gastric emptying
T2D
Gallbladder disease
Cirrhosis/fatty liver disease
Venous stasis or thromboembolic disease
Degenerative joint/disc disease
↑breast, prostate, cervical, uterine, & colorectal cancer
Psychological & socioeconomic effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pulmonary Alternations

A

↓chest wall & lung compliance d/t fat accumulation
Breathe at low lung volumes
Thoracic kyphosis/lumbar lordosis
↓FRC/VC/IC/TLC/ERV
Closing volume close to or w/in tidal breathing
↑metabolic demand, WOB, small airway closures V/Q mismatch → hypoxemia
↑pulmonary blood volume
↑oxygen consumption & CO2 production
High minute ventilation ↑WOB
→ lung disease & pulmonary HTN

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

OSA Types

A

Obstructive
Central
Obesity hypoventilation syndrome (Pickwickian)

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

Obstructive Sleep Apnea

A

Cessation airflow but maintain respiratory effort

Abnormal relaxation genioglossus & pharyngeal muscles pull tongue forward

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

Central Sleep Apnea

A

Cessation both airflow & respiratory efforts

Problem in medullary ventilatory center

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

Obesity Hypoventilation Syndrome

A

Pickwickian syndrome
Most severe OSA leading to cor pulmonale (R sided heart failure) r/t morbid obesity
Extreme obesity complication
Long-term OSA
Hypercapnia PCO2 >45mmHg, hypoxia (HPV), cyanosis induced polycythemia, somnolence & eventual R sided heart failure, pulmonary HTN
Nocturnal sleep disruption & central apneic events
Desensitized to CO2
Airway difficulty

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

Polysomnography

A

OSA diagnosis
Apnea >10sec cessation airflow despite respiratory effort against closed glottis
Hypopnea 50% reduction size or number breaths lasts at least 10sec compared to normal
Apnea-hypopnea index (# per hour)
>30 severe
16-30 moderate
<15 mild

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

Uvulopalatopharyngoplasty

A

UPPP
OSA corrective procedure
Enlarges airway
Remove tonsils, part soft palate, & uvula

17
Q

Diathermy Palatoplasty

A

Heat tissue producing scar tightens in 6-8wks

18
Q

Obesity Airway Changes

A

TMJ & atlanto-axial joint & cervical spine movement limited d/t upper thoracic & low cervical fat pads
Redundant tissue folds in mouth & pharynx = narrowed upper airway
Short, thick neck
Measure neck circumference
Shortened distance b/w mandible & sternal fat pads
Difficult to maintain mask airway

19
Q

Cardiovascular Alterations

A

↑total blood volume
↑CO (expanded blood volume puts strain on myocardium)
↑RAAS & SNS activity → HTN
CAD risk present w/ angina, CHF, acute MI, & sudden death
↑L sided heart pressures & L ventricular pressures
EKG L or R ventricular hypertrophy, ischemia, & conduction defects
↑L ventricular wall stress → hypertrophy ↓compliance, impaired L ventricle filling ↑LVEDP → pulmonary edema
Obesity cardiomyopathy

20
Q

Hematologic Alterations

A 
Polycythemia & hypercoagulation
Thromboembolic risk
- DVT risk double
- ↑blood viscosity
- ↑intra-abdominal pressure
- Immobility → venous stasis
21
Q

Gastrointestinal Alterations

A

↑incidence hiatal hernia, GERD, gallbladder disease

Risk aspiration pneumonitis

22
Q

Hepatic Alterations

A

Fatty liver infiltration - inflammation, cirrhosis, & focal necrosis
High prevalence nonalcoholic fatty liver disease
Abnormal LFTs

23
Q

Renal Alterations

A

↑renal plasma flow & GFR

↑renal tubular reabsorption & impaired natriuresis 2° SNS & RAAS activation

24
Q

Endocrine Alterations

A 
Secrete more insulin but resistant to insulin effects
Develop non-insulin dependent T2D
Metabolic syndrome
- Central obesity
- ↑triglyceride levels
- ↓HDL
- Glucose intolerance
- HTN
25
Q

Musculoskeletal Alterations

A 
Osteoarthritis
Degenerative joint disease
Mechanical load weight-bearing joints
Inflammatory response
Back pain
Stress fractures (bone demineralization)
26
Q

CNS Alterations

A

ANS dysfunction
Peripheral neuropathies
Stroke
Idiopathic intracranial HTN

27
Q

Hyperlipidemia

A

↑LDL ↓HDL cholesterol r/t atherosclerosis
CAD
Vascular disease
Pancreatitis

28
Q

Pharmacokinetic Alterations

A

↑blood volume & CO
↓total body water
↑adipose & lean tissue
Variable alterations in protein binding
Organomegaly
Hepatic clearance unchanged despite histological & LFT alterations
↑renal drug clearance (GFR, renal blood flow, tubular secretion)
Lipophilic drugs ↑elimination 1/2 life ↑Vd w/ normal clearance

29
Q

Preop Considerations

A

↑HTN incidence
Pulmonary HTN = dyspnea, fatigue, syncope, tricuspid regurgitation, R ventricular hypertrophy, R axis deviation, prominent PA on CXR
R/L sided ventricular failure
CAD/ischemic heart disease
Excess adipose tissue
Assess peripheral & central venous access
Thromboprophylaxis

30
Q

General Anesthesia

A

↑Succinylcholine dose
Desflurane ↓blood:gas coefficient
Avoid N2O d/t oxygen demands
Short-acting opioids to minimize respiratory depression
Dexmedetomidine - no adverse effects on respiration↑

31
Q

Mechanical Ventilation

A 
PEEP improves FRC & arterial oxygenation
Monitor BP
Recruitment maneuvers to improve oxygenation
Pressure-controlled ventilation
Manipulate I:E ratio
32
Q

Fluid Management

A

Calculate based on lean or IBW

↑blood loss

33
Q

Emergence

A 
Respiratory failure = 1° problem
Extubate fully awake after NMB reversed 
Ensure adequate mechanical ventilation
Change position to semi-upright
HOB >30° 
Wean pressure-support ventilation w/ PEEP
100% FiO2
Place NP airway

Postop CPAP or BiPAP
Mechanical ventilation
Respiratory monitoring

34
Q

Postop Analgesia

A

Opioid-induced ventilatory depression
Multimodal approach to postop pain control
Peripheral nerve block w/ continuous LA infusion w/ or w/o small opioid doses
Local wound infiltration
Opioids based on IBW

AS - N931 Advanced Principles of Anesthesia (17 decks)

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