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AP II Test 2 > Obesity > Flashcards

Obesity Flashcards

1
Q

What BMI is considered being overweight?

What BMI is considered being obese?

What BMI is considered morbidly obese?

A

BMI > 30

BMI > 30 -35

BMI > 40

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2
Q

Obesity is considered being greater than ____% ideal body weight.

A

20%

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3
Q

What is the waist size (M/F) for an obese person?

A

40 male /35 female

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4
Q

Morbidly obese is ___ times ideal body weight.

A

2

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5
Q

What diseases are linked to obesity? (10)

A
  • diabetes
  • heart disease
  • HTN
  • stroke
  • arthritis
  • GERD
  • cancer (endometrial, breast, prostate, colon)
  • high cholesterol
  • endocrine disease
  • REDUCED FERTILITY
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6
Q

What are the types of bariatric surgeries?

A

gastric restriction (AKA gastroplasty)

adjustable gastric banding

gastric restriction with bypass

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7
Q

This is known as:

A

gastric restriction, gastroplasty

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8
Q

What type of gastric restriction is this?

A

adjustable gastric banding

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9
Q

Gastric restriction, both methods, decrease stomach contents by how much?

A

10-20 cc

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10
Q

What is the most common bariatric procedure in Australia and Europe?

A

adjustable banding

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11
Q

Which method is associated with a decreased rate of weight loss?

A

adjustable banding

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12
Q

What is the most common bariatric procedure in the US?

A

gastric bypass

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13
Q

What type of gastric surgery is this?

What is the extension limb called?

A

gastric bypass

Roux limb varies between 75-150 cm

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14
Q

A shorter Roux limb results in greater weight loss. True or false?

A

false, longer one

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15
Q

What is the gold standard of weight loss surgery?

A

bypass

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16
Q

What is the “metabolic syndrome”?

A

Triad of:

Obesity

HTN

Type II DM

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17
Q

Excess body mass leads to what regarding metabolic demand and cardiac output?

A

Increased metabolic demand

Increased CO

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18
Q

What is a result of increased CO with respect to workload and pulmonary flow?

A

Increased workload leading to LVH

Pulmonary HTN → Cor Pulmonale → right heart failure

in short, increases pulmonary flow

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19
Q

What are cardiovascular issues that may result from obesity? (5)

A

Increased risk of arrhythmias
Hypertrophy
Hypoxemia
Fatty infiltration of conduction system
Increased catecholamines

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20
Q

How much CO is needed for each kg of fat? (L/min)

A

0.01 L/min

21
Q

During cardiac evaluation of obese pt, assess for: (4)

A

prior MI

HTN

angina

PVD

22
Q

Sudden cardiac death is more prevalent with: (2)

A

LVH

ventricular ectopy

23
Q

What do you need to evaluate in EKG for obese patients? (2)

A

axis deviation

atrial tachyarrhythmias

24
Q

What does this strip indicate?

A

LVH in lead V5

25
Q

Severely obese total body water is ____ %.

Estimated blood volume in obese patient is about ____ mL/kg of actual body weight.

A

40%

50 mL/kg

26
Q

What do you consider when replacing fluid in an obese patient?

A

avoid rapid rehydration

hetastarch at ideal body weight

albumin 5-25% as indicated

crystalloid for blood loss 3:1

27
Q

What are the respiratory consequences of obesity?

A

Increased CO2 production

Increased O2 consumption

28
Q

In obese patients, treat like they have restrictive lung disease. As a result, you may be encountered with these issues:

A

decreased chest wall compliance

diaphragm forced cephalad

decreased lung volumes

FRC may fall below closing capacity resulting in alveolar collapse and V/Q mismatch

29
Q

What is the Desaturation Theory?

A

FRC is reduced by 1.5 L with changing body position.

30
Q

If BMI > 43, time to desaturate is < ____ minutes.

A

2

31
Q

What is the primary source of oxygen reserve during apnea?

A

expiratory reserve volume

32
Q

What changes will be affected from least to greatest in pulmonary function tests?

A

tidal volume

inspiratory reserve volume

expiratory reserve volume greatly reduced

33
Q

What is obesity-hypoventilation called?

A

Pickwickian syndrome

34
Q

What are the consequences of Pickwickian syndrome?

A

hypercapnia

cyanotic from hypoxemia

polycythemia

pulmonary HTN

somnolence

sleep apnea OSA

biventricular failure

35
Q

What are GI concerns for obese patients? (4)

A

SEVERE RISK OF ASPIRATION

GERD

hiatal hernia

increased abdominal pressure

36
Q

What is the best treatment for obese patients regarding GI issues?

A

pre-op with H2 blockers night before surgery!

37
Q

What are pharmacological considerations for obese patients?

A

increased volume distribution

increased GFR and clearance of untransformed drugs

increased requirements

38
Q

Des results in quicker wake up than Sevo. True or false?

A

false

39
Q

Since increased volume of distribution in obese patient, what will we do as a result for our induction anesthetics?

A

give larger loading dose and less frequent maintenance dose

40
Q

What drugs do we dose on ideal body weight and why?

A

rocuronium

water soluble

41
Q

What drugs do we dose on total body weight and why?

A

propofol, except on induction (use IBW)

Sux

Versed but will cause somnolence

42
Q

To decrease the risk of aspiration pneumonitis, consider what 2 drugs?

A

H2 antagonist

metoclopramide

43
Q

Difficult ventilation will be attributable to what factors?

A

age > 55

snoring

lack of teeth

BMI > 26

44
Q

Important induction airway equipment not to forget:

A

glidescope

nasal trumpet

introducer

45
Q

What are the 6 D’s of difficult airways?

A

Disproportion

Distortion

Decreased thyromental distance

Decreased inter-incisor (mouth opening distance)

Decreased ROM

Dental overbite

46
Q

When will we need higher FiO2 with regards to positioning in obese pts?

A

trendelenberg

lithotomy

prone

47
Q

What is the best intraoperative position for an obese patient?

A

reverse trendelenberg

48
Q
A

AP II Test 2 (7 decks)

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