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Principles of Anesthesia II (Fall 2023) > Obesity (Exam III) > Flashcards

Obesity (Exam III) Flashcards

1
Q

What is the #1 cause of medically-related preventable deaths?

A

Smoking

Obesity is #2.

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2
Q

What is an android body fat distribution associated with?

A

↑ O₂ consumption
CV disease

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3
Q

Gynoid body fat distributions are _____ metabolically active and not as associated with ______ disease.

A

less ; cardiovascular

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4
Q

Total blood volume is ______ in obesity.

A

increased

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5
Q

Obesity blood volume to weight ratio is typically lower than _____ mL/kg.

A

50 mL/kg

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6
Q

What occurs with cardiac output in obese patients?

A

CO will ↑ by 20-30 mL per kg of excess body fat.

CO increases due to LV dilation and ↑ stroke volume.

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7
Q

What causes cardiac dysrhythmias in the obese patient?

A
  • Fatty infiltrates in the conduction system
  • CAD
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8
Q

What EKG changes are typical of the obese patient?

A
  • ↓ QRS voltage
  • LV hypertrophy
  • Left axis deviation
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9
Q

Increased levels of what coagulative factors are noted in obesity?

A
  • Fibrinogen
  • Factor VII
  • Factor VIII
  • Von Willebrand

Increased levels = hypercoagulability.

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10
Q

Why does endothelial dysfunction occur in the obese patient?

A

Due to ↑ factor VIII and von Willebrand.

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11
Q

Gastric ______ and _____ are increased in the obese patient.

A

Gastric volume and acidity are increased.

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12
Q

What intubation risk factors are present in an Obese patient due to changes in the GI system?

A
  • Delayed gastric emptying
  • ↑ chance of gastric volume > 25mL
  • ↑ chance of pH < 2.5
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13
Q

What are the results of increased intragastric pressure secondary to obesity?

A
  • LES relaxation
  • Hiatal hernia formation
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14
Q

Glomerular _______ occurs with obesity due to increased renal blood flow.

A

hyperfiltration

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15
Q

What are the consequences of increased renal tubular absorption secondary to obesity?

A
  • Impaired natriuresis
  • RAAS activation
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16
Q

What are the endocrine effects of obesity?

A
  • ↑ SNS activity
  • Insulin resistance
  • Enhanced NE and Ang II activity
  • Na⁺ retention
  • Thyroid hormone resistance
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17
Q

Metabolic syndrome diagnosis requires 3 of the following:

A
  • Abdominal obesity
  • ↓ HDLs
  • ↑ Triglycerides
  • Hyperinsulinemia
  • Glucose intolerance
  • Hypertension
  • Inflammatory state
  • Thrombotic state
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18
Q

What ethnicities are at higher risk for metabolic syndrome?

A

Hispanics and South Asians

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19
Q

What drugs may cause metabolic syndrome?

A
  • Chronic corticosteroids
  • Antidepressants
  • Antipsychotics
  • Protease inhibitors
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20
Q

Differentiate OSA and hypopnea.

A
  • OSA: Complete cessation of breathing (5 times or more an hour)
  • Hypopnea: Airflow reduction by ≥ 50% (15 times or more an hour)
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21
Q

What would a mild apnea/hypopnea index be?

A

5 - 15 events/hour

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22
Q

What would a moderate apnea/hypopnea index be?

A

15 - 30 events/hour

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23
Q

What would a severe apnea/hypopnea index be?

A

> 30 events/hour

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24
Q

CPAP is necessary for treatment of OSAHS (Obstructive sleep apnea and hypopnea syndrome) due to risk of what complications?

A
  • Systemic/Pulmonary HTN
  • LVH
  • Dysrhythmias
  • Cognitive impairment
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25
Q

What’s another name for Obesity Hypoventilation Syndrome?

A

Pickwickian Syndrome

26
Q

What causes Pickwickian syndrome?

A

Long-term OSA

27
Q

What does Pickwickian syndrome cause?

A

Pulm HTN and Cor Pulmonale

28
Q

How is Pickwickian syndrome diagnosed?

A
  • > 30 BMI
  • Awake hypercapnia
29
Q

What drug(s) classes are used to treat obesity?

A
  • Phentermine
  • Orlistat
  • OTC Herbals
  • GLP-1 Agonists
30
Q

How does Phentermine work?
What are it’s side effects?

A
  • Sympathomimetic that decreases appetite
  • ↑HR, palpitations, HTN, dependence
31
Q

How does Orlistat work?
What are the adverse effects associated with it?

A
  • Orlistat blocks absorption of dietary fat
  • Liquid, fatty stools, urgency, flatulence and cramping.
  • Fat soluble vitamin deficiencies
32
Q

How can Orlistat precipitate coagulopathy?

A

Possible Vit K deficiency → prolonged PT

33
Q

Which herbals are pancreatic lipase inhibitors?

A

Caffeine
Green Tea

34
Q

How do ginseng, ephedra, and sunflower oil “treat” obesity?

A

Appetite suppression

35
Q

What berry is an OTC herbal energy stimulant?

A

Acai

36
Q

What OTC Herbals regulate lipid metabolism?

A
  • Soybean Oil
  • Fish Oil
  • Oolong tea
37
Q

For patients taking a GLP-1 Agonist on a weekly basis, it is recommended to hold the dose for _____ prior to surgery.

A

1 week

38
Q

How would a patient be treated if they forgot to hold their GLP-1 Agonist prior to surgery?

A

The patient is to be treated as a full stomach or gastric contents need to be evaluated by US.

39
Q

CPAP pressures of > ______ cmH₂O are associated with difficult mask ventilation.

A

10 cmH₂O

40
Q

How does closing capacity compare to tidal breathing in the morbidly obese patient?

A

Closing capacity ≈ Tidal breathing

Especially when recumbent/supine.

41
Q

What is the most important respiratory/ventilatory intervention that can be done for the obese patient prior to intubation?

A

Preoxygenate.

42
Q

What can possibly lead to renal failure when a morbidly obese patient is placed in the supine position?

A

Rhabdomyolysis of the gluteal muscles

43
Q

Is prone or lateral decubitus positioning preferred in the obese patient?

A

Lateral decubitus

44
Q

What oropharynx change occurs with obesity?

A

Oropharynx shape becomes elliptical w/ a short transverse and long AP axis.

45
Q

Increased ________ ________ deposited into the airways can complicate airway management.

A

Adipose tissue

46
Q

What is the relationship between degree of obesity and pharyngeal area?

A

Inverse relationship

More obese = Less pharyngeal area.

47
Q

What predictors of difficult intubation are of particular import in the obese patient?

A
  • BMI (though not all the time)
  • Small mouth opening
  • Large Teeth
  • Limited neck mobility
  • Retrognathia
48
Q

What axes need to line up for intubation?

A

Laryngeal, Pharyngeal, and oropharyngeal

49
Q

How quickly will a patient with a normal BMI desaturate from 100% to 90% SpO₂?

A

6 minutes

50
Q

How quickly will a patient with a morbidly obese BMI desaturate from 100% to 90% SpO₂?

A

3 minutes or less

51
Q

What is the best positioning on an OR table for recruitment in an obese patient?

A
  1. 30° Reverse Trendelenburg
  2. 25-30° with the head up
52
Q

What measures should be take for alveolar recruitment to prevent atelectasis and desaturation in the obese patient?

A
  1. CPAP 10 cmH₂O during preoxygenation
  2. Positioning
  3. Recruiting maneuvers then PEEP 10cm
  4. Mechnical ventilation after induction
53
Q

Which drug classes have exaggerated responses in obese patients (particularly those with OSA) ?

A
  • Opioids
  • Benzo’s
  • Propofol
54
Q

Which opioids are preferred in obese OSA patients?

A

Short-acting Opioids

  • Remifentanil
  • Fentanyl
55
Q

______ is not a favored volatile in obese patients due to their greater O₂ demand.

A

N₂O

56
Q

What drug class (in general) will diminish ventilatory response to CO₂?

A

VAA’s

57
Q

Initial dosing of drugs in obese patients should be based on ______ _______.

A

Lipid solubility

58
Q

Which common anesthetic drugs are dosed based on Ideal Body Weight (IBW)?

A
  • Propofol
  • Vecuronium
  • Rocuronium
  • Remifentanil
59
Q

Which common anesthetic drugs are dosed based on Total Body Weight (IBW)?

A
  • Midazolam
  • Succinylcholine
  • Cisatracurium
  • Fentanyl
  • Sufentanil
60
Q

IV fluids requirements are ______ than what’s predicted in order to prevent acute tubular necrosis in the obese patient.

A

greater

Principles of Anesthesia II (Fall 2023) (23 decks)

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