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HA > obesity > Flashcards

obesity Flashcards

1
Q

obesity stats

A

2nd leading cause of preventable death
68% of pop considered overweight/obese
multifactoral chronic disease

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2
Q

Ideal Body Weight

A

male: 105lbs +6lbs for ever inch over 5ft
female: 100lbs +5lbs for evert inch over 5ft.
* *helpful in calculating drug dose to avoid toxicity or hemodynamic instability

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3
Q

Body Mass Index

A

-accepted measure of of body build that normalize for adiposity and height
kg/m2

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4
Q

overweight

A

BMI 25-29

weight is 20% more than ideal body weight

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5
Q

obesity

A

BMI> 30
have deviations in anatomic, physiologic, biochemical
-associated with morbidity of stroke, ischemia heart disease, DM, certain CA

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6
Q

morbidly obese

A

BMI>40

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7
Q

super-obese

A

BMI>50

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8
Q

class 123

A

1: BMI 30-34
2 35-39
3 >40

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9
Q

increased incidence of DM and heart vascular disease leads to

A 
difficult intubation
decreased PaO2
increased gastric volume
decreased gastric pH
increased post op wound infection
increased rick of pulm embolism
sudden death
poor 30 day outcome
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10
Q

obesity problems

A

obstuctive sleep apnea (restrictive lung disease
HTN
Ischemia heart disease
CHF
delayed gastric emptying—aspiration risk
DM
hepatobiliary disease
Thrombembolic disease- needs SCD, sub heparin
musculoskeletal disease

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11
Q

Post Op DVT risk factors

A

venouse stasis
BMI >60?
trunkalobesity
OSA

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12
Q

resp changes obesity

A

decreased FRC: less safe apnea time
decreased ERV
increase MV
TV may fall into range of closing capacity
increase O2 consumption/CO2 production
decreased chest wall compliance
increased pull resistance: restrictive lung pattern
Pulm function test may remain normal: until obesity worsens and see lung disease and pulm HTN

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13
Q

positing changes obesity

A

supine: difficulty preO2ing, sniffing position, can see rapid desat
trendelenberg: can lead to V/Q mismatch, hypoxemia, increased R to L shunt

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14
Q

obesity and airway

A

abundant soft tissue inure airway
obstruction of airway
can impair mandible and cervical mobility creates difficulty maintaining a mask airway
difficult laryngoscopy and intubation
**consider fiberoptic
difficult airway: 5% risk neck circum of 40
35% risk neck circum of 60

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15
Q

Ramp up

A

premade wedge, or blankets
pt at 25degrees
up from midaxillary

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16
Q

cardiac changes in obesity

A

**can heart handle induction? most stressful part
CO increase for each kg of adipose= increased circulating blood volume which can put strain on myocardium
-cardiomegla, large LV
*CXR and ECG
Arterial HTN risk X2 compared to lean pt
risk for CAD doubled: angina, CHF, acute MI, sudden death
Increased Lsided heart problems and L ventricular hypertrophy

17
Q

Pre-op determine cardiac tolerance for fat people

A 
have limited reserve for : hypotension
tachycardica
fluid overload
* increase pulm blood ruins RV
increased CO ruins LV  =BIventricular failure
18
Q

Hyperlipidema

A 
increased LDL-linked to atherosclerosis
decreased HDL-same
Can lead to:
-coronary art disease
-vascular disease
-pancreatitis
19
Q

obstructive sleep apnea

A 
obesity- Independent risk factor 5% obese pt
*less than 15% cases are diagnosed 
characterized by: apena>10sec despite res effort against closed glottis
-hypopnea 4%decrease in arterial O2 sat
-frequent apnea episodes during sleep:
-O2 desat
-impaired concentration
-snoring
-morning HA
20
Q

Severity of OSA measured by apnea hypoxia index # or hypopneic episodes

A

diagnosed by at least 5 episode of apnea, hypopnea or both during 1 hr
gradeL mild5-15/hr
moderate 15-30/hr
severe>30/hr

21
Q

OSA risk factors

A 
middle age
male
obesity
ETOH use
drug induce sleep aids
abd fat distribution 
neck girth >17inch men >16inch girl
22
Q

OSA results in

A 
hypoxemia
R heart failure 
hypercapnia
pulm and systemic vasoconstriction 
polycythemia
resp acidosis during sleep
arterial hypoxmia
systemic HTN
pulm HTN
23
Q

OSA and preop

A 
80-95% undiagnosed
Ask about
-sleeping patterns
-snoring
-daytime somnolence
**sould identify pts at risk for OSA
24
Q

obesity and hypoventilation syndrome (OHS) Pickwickian syndrome

A

extreme obesity
long term complications of OSA
airway difficulty
nocturnal central apenic events
-apnea withOUT resp effort
Theory: loss of pt hypercarbic drive to breathe due to progressive desensitization of res enter
-loss of central medicated response: rain never says wake up and breathe
**should be admitted after surg NOT sent home

25
Q

OHS characterized

A 
obesity 
hypercapnia
daytime somnlence
arterial hypoxemia
pulm HTN
resp acidosis
R heart failure
*difficult airway
26
Q

obesity and thromboembolic

A

risk for DVT doubled
polycythemia
increased intra-abd pressure
*immobility

27
Q

obesity and GI

A

gastro-esophogeal reflex

  • hiatal hernia increased risk
  • increased gastric volume and intro gastric pressure: emptying delays
  • gastic acidity: increased risk for aspiration PNA
  • gastic volumes >25
  • Ph<2.5–increased parietal cell secretion
28
Q

Hepatic obesity

A

fatty liver, abnormal LFT

fluorinated volatile anesthesia

29
Q

Metabolic obesity

A

resistance to effect of insulin

adult onset DM

30
Q

Pre-Op eval obesity

A

focus on difficulties obesity present to anesthesia provider

likely admit

31
Q

airway pre-op obesity

A 
hx previous difficulty airway
OSA
access ROM-neck
mouth opening
thryomental distance and mallampati
interior of mouth
**neck size: single best predictor o problematic intubation
32
Q

fat induction

A

identify systems of ever resp disease:
-orthopena, OSA, OHA, hx airway obstruction
CXR,
Room air O2sat-preop 92% probable admit
ABG
pull function test- if pronounced diseased
**optimize pulm status pre-op

33
Q

fat preop CV

A 
signs of HTN, RV/LV hypertrophy, pull HTN
IV access
ECG CXR--must with fat 
ECHO, LV ejection fraction--may have
cardiac clearance if needed
previous diet aids:
-epidrine--MUST be off!
-phenfen--MUST have ECHO!
34
Q

fat preop endocrine metabolic and GI

A

BGL 6 poor control

35
Q

fat liver preop

A

weight loss even albs can revers elevated liver enzymes
-fatty infiltration: increased prevalence of nonETOH fatty liver disease
often hace altered histology and LFTs: normal clearance

36
Q

Preop labs fat

A

hepatic function
albumin level
glucose
coags- if risk factor

37
Q

monitor fat

A 
BP cuff correct size
iv access
pulse ox
abg
ETCO2
38
Q

fat positioning

A

special tables or 2 together
ramp up
max wt per vicky 205kg
strapping pt carefully-skin cponscerns
protect pressure points
consider 2 arm boards
supine—compression of vena cava, FRC and oxygenation decreased
change from sitting to supine–significant change in CO, PAP, O2 consumption
*head up reverse Tberg: provides longest safe apnea period
*prone: increase intra abd pressure, worsen vena cava and aortic compression decreased FRC,
*lateral postion favored over prone!

39
Q

fat aspiration prophylaxis

A 
pre-op anxiety
Tx: H2 receptor antagonist
sodium citrate (bicitra) 30ml alkaline
Reglan
Omeprazole

HA (5 decks)

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