Obesity Flashcards
T/F: Adipose tissue is considered an organ?
True
What is the 2nd leading cause of preventable death?
Obesity
How to calculate BMI?
Weight (Kg) / Height (m2)
or {Weight (lbs)/Height(in2)} x 703
BMI Classes
25-29.9=Overweight 30-34.9=Obese Class 1 35-39.9=Obese Class 2 40-44.9=Obese Class 3 >45= Obese Class 4
Which class is considered Extreme Obesity? Severe Obesity?
Extreme Obesity=Class 3 (BMI 40-44.9)
Severe Obesity=Class 4 (BMI >45).
What is the typical cutoff BMI for Surgery centers?
BMI >45
What is the Broca’s Index?
A formula to calculate Ideal Body Weight
What is the Ideal Body Weight Formula?
Male= Height(cm)- 100 Female= Heigh(cm)- 105
How do you calculate Lead Body Weight?
First calculate IBW and multiply by 1.3
Which adipose distribution is labeled as “Apple Shaped”?
Android
Which adipose distribution is labeled as “Pear Shaped”?
Gynecoid
Which adipose distribution (Gynecoid/Android) is associated with heart disease, DM, HTN, dyslipidemia, death?
Android
How does cardiac output change with obesity?
Increased CO of 0.1L/min for each kg of fat
What are reasons for HTN prevalence in obesity?
- Increased blood viscocity
- Hyperinsulinemia
- Increased mineralocorticoids
- Sodium reabsorption
- Compression of kidneys
- RAA Activation
Do obese patients exhibit restrictive or obstructive respiratory loop patterns?
Restrictive
What is changed on flow volume loops in the obese patient?
Decreased: FRC, ERV, VC, TLC
Increased: Deadspace
No change: RV, CC, FVC, FEV1
What is the definition of OSA?
Excessive episodes of apnea (10 seconds) with >5 episodes per hour or 30 per night
T/F: OSA is very well diagnosed and most patients are treated for it adequately?
False; 80-95% are undiagnosed and/or untreated
What is the “Gold Standard” test for OSA?
Polysomnography (PSG)
What easy scoring parameter can be used to diagnose OSA with 93% sensitivity?
STOP-BANG
What does STOP BANG stand for?
Snoring Tiredness Observed apnea Pressure (HTN) BMI (>35) Age (>50) Neck (>15.75in) Gender (Male)
What is Pickwickian syndrome?
Obese Hypoventilation Syndrome
Typically have OSA induced polycythemia, respiratory acidosis, PulmHTN, R CHF
Why do Pickwickian syndrome patients acquire Right sided heart failure?
Hypoxic Pulmonary Vasoconstriction which leads to Pulmonary HTN
(Cor Pulmonale)
T/F: Maternal obesity is related to pregnancy complications; however, these risks are decreased after bariatric surgery?
False; complication risk increased after bariatric surgery
Propofol induction doses are based on ____(LBW/IBW/TBW) versus maintenance infusion doses based on ____(LBW/IBW/TBW)?
Induction dose based on LBW.
Maintenance gtt based on TBW
Which medication must be based on TBW due to the increased fluid compartment and increased pseudocholinesterase levels?
Succinylcholine
Roc/Vec/Cisat should be based on ____(LBW/IBW/TBW) and why?
IBW. Hydrophilic drug; will ensure shorter duration of action and more predictable recovery time
Fentanyl and sufentanyl should be based on ____ (LBW/IBW/TBW) for induction and ____ for infusions?
TBW d/t increased distribution volume, but infusions should be based off LBW
Low lipophilicity drugs should be based on ___(LBW/IBW/TBW)?
IBW
High lipophilicity drugs should be based on ____ (LBW/IBW/TBW)?
TBW
Describe “sniffing” position:
Extension at atlanto-axial joint.
Flexion at lower cervical vertebrae
Obesity changes with GA on Respiratory?
- 50% reduction in FRC compared to 20% in non-obese
- Use PEEP
- TV 6-10ml/kg off IBW
- Intermittent manual “sighs”
How does the obese patients volume replacement change?
Use 45-55ml/kg for for EBV.
Increased Total Body Volume, but proportionately decrease Estimated Blood Volume
