Obesity/Difficult Airway Flashcards
How is BMI calculated
Kg/m^2
How is OSA different from OSH
OSA = cessation of airflow for >10 seconds 5 or more times per hour of sleep
OSH = decrease in airflow of >50% for more than 10 seconds 15 times or more per hour of sleep
How much does Spo2 decrease in OSH and OSA
> 4%
systemic manifestations of OSA
cardiac
pulmonary
GI
renal
neuro
cardiac: HTN and LVH, pHTN can occur
pulm: increased V/Q mismatch
GI: upward stomach displacement 2/2 extra abdominal pressure placing them at risk for GERD
Renal: potential HTN nephropathy
Neuro: hypersomnolence and increased sensitivity to anesthetic
How is OSA distinguished from Pickwickian syndrome
what can develop with PS
PS = chronic hypoventilation worse during sleep, reults in elevation of PaCO2 levels
PS: BMI >30, PaCO2 > 44 mm hg, no alt explanation for hypoventilation
-pts often have polycythemia, cor pulmonale, somnolence
what respiratory parameters can be used for extubation
RR 10-30
Sa)2 > 95% on FiO2 0.4
VC > 10mL/kg IBW
Tv over 5mL/kg IBW
why is blood glucose control important in the perioperative period
hyperglycemia can lead to impaired immune response so increase for infection, impaired wound healing, dehydration, electrolyte disturbances
in this patient with OSA and lap gastric bypass. Few hours later PACU nurse informs that he is disoriented what is DDx
1) VS: hypoxia, hypotension, arrhythmia
2) anesthesia: residual anesthetic, narcotics
3) delirium tremiensfrom withdrawal from previous unknown substance abuse agent
4) potential metabolic and endocrinologic causes: hypoN,K,Ca,glucose,thermia,thryoid, addison, and hyperglycemia
5) neuro: stroke, cerebral edema, post ictal state
how would you respond to this disoriented patient
make sure pt is adequately oxygenating and ventilating and VS are stable
then focused H and P
listen for breath sounds and look for neuro signs including pupillary size and FND
stat labs: ABG, electrolytes with glucose and CBC
STAT head CT and neuro consult if think it is stroke
