Obesity

Question 1

Upper portion of stomach is stapled to lower part of intestines, leaving only a small gastric pouch

Answer 1

Roux-en-y gastric bypass

Question 2

80% of stomach is removed, along with a significant portion of small intestine, which leaves behind a small absorptive area

Answer 2

Jejunoileal bypass or biliopancreatic diversion

Question 3

How much is obesity over ideal body wt?

Answer 3

> 20%

Question 4

What are 4 different ways to measure body composition?

Answer 4

1. Underwater weighing (hydrodensitometry)
2. Skinfold
3. Bio electrical impedance analysis (BIS)
4. Dual-energy x-ray absorptiometry (DEXA)

Question 5

What is the most commonly used quantified of obesity?

Answer 5

BMI

Question 6

BMI 25-29.9

Answer 6

Overweight

Question 7

BMI 30-34.9

Answer 7

Class 1 (low risk)

Question 8

BMI 35-39.9

Answer 8

Class 2 (moderate risk)

Question 9

BMI >40

Answer 9

Class 3 (high risk)

Question 10

How to calculate LBW?

Answer 10

TBW minus fat weight

Question 11

Which is better, LBW or IDW?

Answer 11

LBW because obese have 20-40% extra lean mass that is not accounted for in IBW

Question 12

Transdermal and subcutaneous absorption for obesity

Answer 12

Poor subcutaneous fat circulation = decreased subcutaneous absorption

Question 13

Can a large subcutaneous fat layer interfere with a good intramuscular injection?

Answer 13

Yes

Question 14

Which drugs show an increased Vd (distribution) in obesity?

Answer 14

Lipophilic drugs

Question 15

Which drugs show little change in Vd for obesity pts?

Answer 15

Hydrophilic

Question 16

Risk of failed block is about 1.5x higher when BMI is greater than what?

Answer 16

30mg/m^2

Question 17

Obese pts require how much local anesthetics for spinal/epidural anesthesia?

Answer 17

~20% less

Question 18

Which volatile agent do you NOT use for obesity?

Answer 18

Isoflurane

Question 19

Sux dose based on what for obesity?

Answer 19

TBW

Question 20

Vec, cisatracurium, and atracurium are dosed base on what in obesity?

Answer 20

IBW or LBW

Question 21

Rocuronium is dosed based on what for obesity?

Answer 21

IBW or LBW

Question 22

What kind of doses are needed for pancuronium in obesity?

Answer 22

Higher

Question 23

Obese subjects have a what kind of reversal time?

Answer 23

4 fold increase

Question 24

Sugammadex is dosed based on what for obese?

Answer 24

TBW or IDW plus 40%

Question 25

Thiopental induction and maintenance is dosed on what for obsesity?

Answer 25

Induction: LBW
Maintenance: TBW

Question 26

Dexmedetomidine is dosed based on what for obesity?

Answer 26

LBW or IDW

Question 27

Propofol induction and maintenance is dosed in what for obese?

Answer 27

Induction: LBW
Maintenance: TBW

Question 28

Etomidate is based on what for obese?

Answer 28

LBW

Question 29

Fentanyl is dosed based on what for obese?

Answer 29

LBW

Question 30

Which opioid has the highest lipophilic for obese?

Answer 30

Sufentanil

Question 31

Remifentanil is dosed based on what?

Answer 31

IBW or LBW

Question 32

What postop supplementation is used with obese? (6)

Answer 32

1. NSAIDs
2. Alpha2 receptor agonists
3. Ketamine
4. Na channel blockers
5. Pregabalin
6. Nonopioid analgesics

Question 33

Obesity is an independent risk factor for what?

Answer 33

VTE

Question 34

Low VTE risk for obese?

Answer 34

LMWH or IPC

Question 35

High VTE risk for obese?

Answer 35

LMWH and IPC (dosing LMWH higher than normal)

Question 36

Extend prophylaxis period for obese to how long?

Answer 36

10-15 days