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Advanced Anesthesia 2 > Obesity > Flashcards

Obesity Flashcards

1
Q

BMI 25-29.9

A

Overweight

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2
Q

BMI 30-34.9

A

Obese Class I

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3
Q

BMI 35-39.9

A

Obese Class II

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4
Q

BMI 40-44.9

A

Obese Class III / Extremely Obese

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5
Q

BMI > 45

A

Obese Class IV / Severe Obesity

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6
Q

Surgery centers are not supposed to take care of patients with a BMI of ____ or greater

A

45

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7
Q

IBW for male

A

Height (cm) - 100

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8
Q

IBW for female

A

Height (cm) - 105

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9
Q

LBW calculation

A

IBW x 1.3

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10
Q

Major physiologic functions of adipose tissue

A

secrete proteins, endocrine progan that has readily convertble and usable energy, Liver fat metabolism

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11
Q

Liver fat metabolism is extremetly important because all cells contain some ________ fats synthesized by the liver.

A

unsaturated

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12
Q

Which type of obesity is associated with more comorbidities

A

android

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13
Q

For each kg of fat there is an increased CO of ____

A

0.1L/min

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14
Q

The effects of fat on the heart include increased CO, 02 consumption and _____ production

A

C02

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15
Q

HTN in obesity is attributable to what?

A

increased blood viscosity, hyperinsulinemia, increased mineralcorticoids, sodium reabsorption, compression of the kidneys, impaired sodium excretion, RAA activation

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16
Q

The effects of obesity on the respiratory system include ________ compliance, a __________ F/V loop pattern.

A

decreased / restrictive

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17
Q

What is decresed with obesity in regards to the respiratory system?

A

FRC, ERV, VC, TLC

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18
Q

What is increased with obesity in regards to the respiratory system?

A

Dead space

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19
Q

What has no change in regards to obesity and the respiratory system?

A

RV, CC, FVC, FEV1

20
Q

OSA rates are directly proportional to ____.

A

BMI

21
Q

For BMI >35 OSA is present in ___ to ___%

A

71-77%

22
Q

Definition of OSA

A

excessive episodes of apnea (10 seconds) and hypopnea

23
Q

Describe episodes of apnea

A

Obstruction > hypoxia and hypercarbia > surge of muscles to open airway > period of hyperventilation > reverses hypercarbia> normal breathing > start all over

24
Q

Effects of OSA

A

hypoxia, hypercarbia, systemic and pulmonary hypertension, and cardiac dysrhythmias

25
Q

Gold standard test for OSA

A

polysomnography (PSG)

26
Q

STOP-BANG is easy and up to ____ sensitive

A

93%

27
Q

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

A

somnolence

28
Q

Why can Pickwickian syndrome lead to right sided heart failure

A

HPV, pulmonary hypertension leading to Cor Pulmonale

29
Q

With maternal obsesity, complications correlate more to pre-pregnancy ______. The risk for 1st 6 weeks miscarriage ________.

A

obsesity / doubles

30
Q

Is there an increased or decreased risk for maternal issues after bariatric surgery

A

increased

31
Q

What is increased with the obese in terms of body composition

A

Vd, blood volume

32
Q

Total body water is ________ in the obese

A

decreased

33
Q

T/F Obese people have alterations in protein binding and obesity can affect on lipophilicity of the drug

A

TRUE

34
Q

If a drug has a LOW lipophilicity how should it be dosed?

A

IBW

35
Q

If a drug hasa HIGH lipophilicity how should the drug be dosed?

A

TBW (most of the time) examples include digoxin, remifentanil, procainamide

36
Q

Review pharmacokinetic changes associated with obesity

A

slide 27

37
Q

Propofol induction dose is based on _____ while maintenance dose is based on _____

A

LBW / TBW

38
Q

Succinylcholine intubating dose is based on _____

A

TBW

39
Q

Rocuronium, vecuronium and cisatracurium doses are all on ______

A

IBW

40
Q

Fentanyl loading dose is based on ____ and maintenance doses are based on _____. (think it’s opposite of propofol)

A

TBW / LBW

41
Q

Remifentanil infusion rates based on _____

A

IBW

42
Q

Sugammadex reversal doses are based on _______

A

TBW

43
Q

PEEP of < ____ cmH20 achieves improvement in FRC and arterial 02 tension but may decrease ___ and ____ delivery

A

15 / CO / 02

44
Q

tidal volumes should be __ to __ ml/kg of ____

A

6-10 / IBW

45
Q

Intermittent manual sighs may help ______

A

FRC

46
Q

Obese folks have an increased TBV but proportionally decreased EBV. What should you use for your calculation?

A

44-55ml/kg

Advanced Anesthesia 2 (4 decks)

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