Obesity Flashcards
Morbid Obesity Periop Complications
Anes: difficult airway
Cardiac: HTN, CAD, DVT/PE, difficult eval 2/2 sedentary lifestyle
Resp: rapid desat with apnea (decreased FRC), Pickwickian syndrome, OSA, postop apnea
GI/Endo: aspiration, metabolic sydrome, DM II, NASH
Neuro: CVA
Other: difficult positioning, altered Rx effects, OA
Morbid Obesity and Ambulatory Surgery Considerations
PreOp
- Patient’s age
- Coexisting disease: extent, severity, optimization
- Potential undiagnosed OSA
- Anatomical and physical abnormalities
IntraOp
- Surgical procedure
- Anesthesia requirements
- Capabilities of facility
PostOp
- Adequacy of post-discharge care
- Opioid requirements
How Does a Patient’s Respiratory Mechanics Change when Moving from Upright to Supine Position
Closing capacity unaffected
Relationship with FRC worsened resulting in early airway closure and shunting = rapid desaturation
Obesity and Drug Pharmokinetics
Lipophilic (Propofol, Benzos, Opioids, Barbs, Cisatracurium, Sux) larger vol distribution 2/2 increased deposition into body fat
- Initial = TBW
Hyprophilic (Vec, Roc, Remi)
- Initial = IBW
*Pharmacologic effects extremely complicated therefore can base initial dose on IBW and titrate additional dosing to clinical effect
Volatiles - with exception of very long cases (>4 hrs) shouldn’t matter choice
- Iso = soluble
- Sevo = less soluble
