obesity Flashcards by Sydney Elmore

how many calories are required to produce 1g of body fat

9 calories

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1g of carbs provides how many calories

4 calories

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1g of protein provides how many calories

4 calories

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1st and second leading causes of preventable death

1st smoking
2nd obesity

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android obesity overview

most common in men and metabolically active
characterized by central visceral or abdominal fat accumulation
waist size >40 inches for men and >35 inches for women
associated with increased risk of ischemic heart disease, HTN, dyslipidemia, insulin resistance, death

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gynecoid obesity overview

more common in women, characterized by gluteal and femoral fat accumulation
metabolically inactive, primarily used for energy storage
more likely to develop joint disease and varicose veins
reduced incidence of non insulin dependent DM

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metabolic syndrome has at least 3 of the following

fasting plasma glucose >110mg/dL
abdominal obesity (>40 inches in men and >35 in women)
serum triglycerides >150mg/dL
HDL <40mg/dL in men and <50mg/dL in women
BP >135/85mmHg

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BMI=

weight (kg) / height (m^2)

weight conversion is 2.2
height conversion to cm first (2.54) then to meters (cm / 100)
BMI = kg/m^2

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adult BMI classification

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child body weight class (2-18y)

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IBW calculation (men v women)

men: height (cm) - 100
women: height (cm) - 105

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respiratory effects of obesity

produces a restrictive ventilatory effect
reduction in FRC (due to decrease in ERV)
decreased VC, TLC

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lung inflation in an obese patient is inhibited because

chest fat compresses rib cage and hinders outward expansion
abdominal fat shifts diaphragm cephalic and compresses the lungs
kyphosis and lordosis develop over time, which alters geometry of ribcage

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how does PaCO2 differ in obese patient

patient may have hypoxemia but PaCO2 is usually normal r/t high diffusing capacity of CO2

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because fat is metabolically active, what increases

O2 consumption, CO2 production, MV

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HELP position

head elevated laryngoscopy position
-idea is to elevate head, shoulders, and upper body above the chest
-horizontal line from sternal notch to external auditory meatus

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how to pre oxygenate obese patient

100% FiO2 + CPAP 10cmH2O until end tidal is >90%. this prolongs time before desaturation occurs by 50%

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when does postoperative hypoxemia happen in this population

immediately or 2-5d postop

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strategies to maximize postop oxygenation include

CPAP or BiPAP after extubation (esp if patient uses it at home)
elevate HOB 30 degrees
early ambulation
control surgical pain (non opioid analgesics and regional)
incentive spirometry

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BV and CO

HR is usually unchanged but SV increases. CO increases an extra 100mL/min for every extra kg of fat

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common EKG changes and causes

low voltage EKG (increased distance between heart and leads)
left axis deviation (stomach pushes heart up and to left, LVH secondary to volume overload and HTN)
right axis deviation (RV hypertrophy from OSA and volume overload)
QT prolongation (increases the risk of sudden death
ischemia (O2 supply and demand mismatch)
dysrhythmias (caused by fatty infiltration of conduction system, myocardial hypertrophy, hypoxemia, hypercarbia, obesity hypoventilation syndrome, ischemic heart disease

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most useful confirmation of pHTN

presence of tricuspid regurg on TEE

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what happens to Vd of lipophilic drugs? hydrophilic?

lipophilic: increased d/t larger fat mass
hydrophilic: increased d/t larger muscle mass and BV

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circulation time in obese population

shortened circulation time due too larger CO

Vd of drugs in obese patient is altered by

increased BV increased CO altered plasma protein binding lipid solubility of the drug

does muscle mass increase?

fat mass AND muscle mass increases

lean body weight (LBW) =

IBW x 1.3

propofol induction dose should be based on maintenance dose should be based on

induction dose should be based on LBW (IBW x 1.3) maintenance dose should be based on TBW

succ intubation dose should be based on

TBW

rocuronium intubation dose should be based n

LBW

vec maintenance dose should be based on

LBW

cis intubation dose should be based on

TBW

fent loading dose should be based on

TBW

sufent maintenance dose should be based on

LBW

remifent loading nad maintenance dose should be based on

LBW

midaz loading and maintenance dose should be based on

TBW (not preop anxiolysis though) r/t increased central Vd

how much of normal epidural dose to give

75%

three sets of muscles that dilate upper aw

tensor palatine (opens nasopharynx) geniglossus (opens oropharynx) hyoid muscle (opens hypo pharynx)

OSA

defined as cessation of air flow for at least 10 seconds with 5 or more unsuccessful efforts to breathe and a >4% reduction in SaO2

hypopnea

common phenomenon in OSA. 50% reduction in air flow for 15 seconds, 15 or more times per hour, and is linked to snoring and decreased O2 saturation

things that increase the likelihood that a patient has OSA

BMI >30kg/m^2 abdominal fat distribution large neck girth (>17inches for men and >16 inches for women)

pathophysiology of OSA

apnea/hypopnea index

categorizes severity of OSA mild: 5-15 episodes/h moderate: 15-30 episodes/h severe: >30 episodes/h

classic triad of dysfunctional sleep

1. apnea or snoring with hypopnea during sleep 2. arousal from sleep 3. daytime somnolence

definitive test for OSA and AHI (apnea hypopnea index) equation

polysonmography, AHI= number of episodes of apnea and hypopnea/hours of sleep

STOPBANG and high risk v low risk for OSA

high risk >3 q answered yes low risk < 3 q answered yes

obesity hypoventilation syndrome

long term consequence of OSA. over time, resp center in medulla fails to adequately respond to hypercarbia classic presentation: apnea during sleep WITHOUT resp effort old school name is pickwickian syndrome

dx criteria for obesity hypoventilation syndrome

BMI >30 awake PaCO2 >45mmHg dysfunctional breathing during sleep

signs of obesity hypoventilation syndrome

obesity hyper somnolence during the day hypoxemia hypercarbia resp acidosis compensatory metabolic alkalosis polycythemia pHTN right HF

type of weight loss procedure: malapsorption examples key points

type of weight loss procedure: restriction examples key points

type of weight loss procedure: combination examples key points

most common s/sx of anastomotic leak include

1. tachycardia 2. fever 3. abdominal pain

Ma Huang

appetite suppressant, natural source of ephedrine. complications of adrenergic overstimulation including HTN, CVA, sz, death

phentermine

NE reuptake inhibitor that acts as appetite suppressant and increases BMR

sibutramine

NE and serotonin reuptake inhibitor, suppresses appetite and increases BMR risks include adrenergic overstimulation and serotonin syndrome

orlistat

lipase inhibitor that reversibly binds to lipase and hinders absorption and digestion of consumed fats. have to supplement ADEK vitamins

for a patient undergoing laparoscopic gastric bypass, fluids should be based on

lean body weight