Obesity Flashcards
BMI 25-29.9
Overweight
BMI 30-34.9
Obese Class I
BMI 35-39.9
Obese Class II
BMI 40-44.9
Obese Class III / Extremely Obese
BMI > 45
Obese Class IV / Severe Obesity
Surgery centers are not supposed to take care of patients with a BMI of ____ or greater
45
IBW for male
Height (cm) - 100
IBW for female
Height (cm) - 105
LBW calculation
IBW x 1.3
Major physiologic functions of adipose tissue
secrete proteins, endocrine progan that has readily convertble and usable energy, Liver fat metabolism
Liver fat metabolism is extremetly important because all cells contain some ________ fats synthesized by the liver.
unsaturated
Which type of obesity is associated with more comorbidities
android
For each kg of fat there is an increased CO of ____
0.1L/min
The effects of fat on the heart include increased CO, 02 consumption and _____ production
C02
HTN in obesity is attributable to what?
increased blood viscosity, hyperinsulinemia, increased mineralcorticoids, sodium reabsorption, compression of the kidneys, impaired sodium excretion, RAA activation
The effects of obesity on the respiratory system include ________ compliance, a __________ F/V loop pattern.
decreased / restrictive
What is decresed with obesity in regards to the respiratory system?
FRC, ERV, VC, TLC
What is increased with obesity in regards to the respiratory system?
Dead space
What has no change in regards to obesity and the respiratory system?
RV, CC, FVC, FEV1
OSA rates are directly proportional to ____.
BMI
For BMI >35 OSA is present in ___ to ___%
71-77%
Definition of OSA
excessive episodes of apnea (10 seconds) and hypopnea
Describe episodes of apnea
Obstruction > hypoxia and hypercarbia > surge of muscles to open airway > period of hyperventilation > reverses hypercarbia> normal breathing > start all over
Effects of OSA
hypoxia, hypercarbia, systemic and pulmonary hypertension, and cardiac dysrhythmias
Gold standard test for OSA
polysomnography (PSG)
STOP-BANG is easy and up to ____ sensitive
93%
Obese hypoventilation (Pickwickian Syndrome) is characterized by inappropriate and sudden ______________, OSA, hypoxia, hypercapnia, arterial hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, right sided heart failure
somnolence
Why can Pickwickian syndrome lead to right sided heart failure
HPV, pulmonary hypertension leading to Cor Pulmonale
With maternal obsesity, complications correlate more to pre-pregnancy ______. The risk for 1st 6 weeks miscarriage ________.
obsesity / doubles
Is there an increased or decreased risk for maternal issues after bariatric surgery
increased
What is increased with the obese in terms of body composition
Vd, blood volume
Total body water is ________ in the obese
decreased
T/F Obese people have alterations in protein binding and obesity can affect on lipophilicity of the drug
TRUE
If a drug has a LOW lipophilicity how should it be dosed?
IBW
If a drug hasa HIGH lipophilicity how should the drug be dosed?
TBW (most of the time) examples include digoxin, remifentanil, procainamide
Review pharmacokinetic changes associated with obesity
slide 27
Propofol induction dose is based on _____ while maintenance dose is based on _____
LBW / TBW
Succinylcholine intubating dose is based on _____
TBW
Rocuronium, vecuronium and cisatracurium doses are all on ______
IBW
Fentanyl loading dose is based on ____ and maintenance doses are based on _____. (think it’s opposite of propofol)
TBW / LBW
Remifentanil infusion rates based on _____
IBW
Sugammadex reversal doses are based on _______
TBW
PEEP of < ____ cmH20 achieves improvement in FRC and arterial 02 tension but may decrease ___ and ____ delivery
15 / CO / 02
tidal volumes should be __ to __ ml/kg of ____
6-10 / IBW
Intermittent manual sighs may help ______
FRC
Obese folks have an increased TBV but proportionally decreased EBV. What should you use for your calculation?
44-55ml/kg
