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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
What's another name for Obesity Hypoventilation Syndrome?
Pickwickian Syndrome
26
What causes Pickwickian syndrome?
Long-term OSA
27
What does Pickwickian syndrome cause?
Pulm HTN and Cor Pulmonale
28
How is Pickwickian syndrome diagnosed?
- > 30 BMI - Awake hypercapnia
29
What drug(s) classes are used to treat obesity?
- Phentermine - Orlistat - OTC Herbals - GLP-1 Agonists
30
How does Phentermine work? What are it's side effects?
- Sympathomimetic that decreases appetite - ↑HR, palpitations, HTN, dependence
31
How does Orlistat work? What are the adverse effects associated with it?
- Orlistat blocks absorption of dietary fat - Liquid, fatty stools, urgency, flatulence and cramping. - Fat soluble vitamin deficiencies
32
How can Orlistat precipitate coagulopathy?
Possible Vit K deficiency → prolonged PT
33
Which herbals are pancreatic lipase inhibitors?
Caffeine Green Tea
34
How do ginseng, ephedra, and sunflower oil "treat" obesity?
Appetite suppression
35
What berry is an OTC herbal energy stimulant?
Acai
36
What OTC Herbals regulate lipid metabolism?
- Soybean Oil - Fish Oil - Oolong tea
37
For patients taking a GLP-1 Agonist on a weekly basis, it is recommended to hold the dose for _____ prior to surgery.
1 week
38
How would a patient be treated if they forgot to hold their GLP-1 Agonist prior to surgery?
The patient is to be treated as a full stomach or gastric contents need to be evaluated by US.
39
CPAP pressures of > ______ cmH₂O are associated with difficult mask ventilation.
10 cmH₂O
40
How does closing capacity compare to tidal breathing in the morbidly obese patient?
Closing capacity ≈ Tidal breathing *Especially when recumbent/supine*.
41
What is the most important respiratory/ventilatory intervention that can be done for the obese patient prior to intubation?
**Preoxygenate**.
42
What can possibly lead to renal failure when a morbidly obese patient is placed in the supine position?
Rhabdomyolysis of the gluteal muscles
43
Is prone or lateral decubitus positioning preferred in the obese patient?
Lateral decubitus
44
What oropharynx change occurs with obesity?
Oropharynx shape becomes elliptical w/ a short transverse and long AP axis.
45
Increased ________ ________ deposited into the airways can complicate airway management.
Adipose tissue
46
What is the relationship between degree of obesity and pharyngeal area?
Inverse relationship *More obese = Less pharyngeal area*.
47
What predictors of difficult intubation are of particular import in the obese patient?
- BMI (though not all the time) - Small mouth opening - Large Teeth - Limited neck mobility - Retrognathia
48
What axes need to line up for intubation?
Laryngeal, Pharyngeal, and oropharyngeal
49
How quickly will a patient with a normal BMI desaturate from 100% to 90% SpO₂?
6 minutes
50
How quickly will a patient with a morbidly obese BMI desaturate from 100% to 90% SpO₂?
3 minutes or less
51
What is the best positioning on an OR table for recruitment in an obese patient?
1. **30° Reverse Trendelenburg** 2. 25-30° with the head up
52
What measures should be take for alveolar recruitment to prevent atelectasis and desaturation in the obese patient?
1. CPAP 10 cmH₂O during preoxygenation 2. Positioning 3. Recruiting maneuvers **then** PEEP 10cm 4. Mechnical ventilation after induction
53
Which drug classes have exaggerated responses in obese patients (particularly those with OSA) ?
- Opioids - Benzo's - Propofol
54
Which opioids are preferred in obese OSA patients?
Short-acting Opioids - Remifentanil - Fentanyl
55
______ is not a favored volatile in obese patients due to their greater O₂ demand.
N₂O
56
What drug class (in general) will diminish ventilatory response to CO₂?
VAA's
57
Initial dosing of drugs in obese patients should be based on ______ _______.
Lipid solubility
58
Which common anesthetic drugs are dosed based on Ideal Body Weight (IBW)?
- Propofol - Vecuronium - Rocuronium - Remifentanil
59
Which common anesthetic drugs are dosed based on Total Body Weight (IBW)?
- Midazolam - Succinylcholine - Cisatracurium - Fentanyl - Sufentanil
60
IV fluids requirements are ______ than what's predicted in order to prevent acute tubular necrosis in the obese patient.
greater

Harris pimpin (12 decks)

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