Obesity II Flashcards
What are some weight loss medications?
- Meds that suppress hypothalamic appetite regulatory center:
- Phentermine
- Benzphetamine
- Diethylproprion
- Phentermine w/topiramate
- Phendimetrazine
- Drug that blocks fat absorption
- Orlistat
- Inhibits NE and serotonin reuptake
- Sibutramine
- Ephedra
What are the three categories of bariatric surgeries?
- Gastric restriction- goal to restrict food intake
- gastric binding (adjustable)
- gastric sleeve
- Intestinal malabsorption- bypasses part of small intestine
- jejunoileal bypass
- Biliopancreatic diversion
- duodenal switch
- combined restrictive/malabsorbtive
- Roux-en-Y
What are some surgical complications for bariatric surgeries?
- Anastomotic leaks
- stricture formation
- PE
- sepsis
- gastric prolapse
- nutritional complications
- dumping syndrome
________ are the greatest cause of perioperative 30-day mortality of bariatric surgeries.
- Pulmonary emboli
What do you need to assess in your pre-op evaluation of an obese patient?
- Assess patient in a non-judgemental fashion
- emphasis should beon the difficulties obesity presents to the anesthesia provider
- discuss the likely post-op course
- Assess all the systems
What is the one extra thing you would do in the airway assessment of an obese pt?
- Measure the neck circumference
- single best predictor of difficult intubation
- 40 cm = 5%
- 60 mc = 35%
What is the screening tool for OSA?
- STOP-BANG questionnaire
- snoring?
- tired?
- observed?
- High blood pressure?
- BMI?
- Age?
- neck size?
- gender?
What kind or pre-op studies would you want to do to assess the pulmonary situation of an obese patient?
- CXR
- Room aire SaO2
- ABGs
- PFTs
- Optimize pulmonary status preop
How should you assess an obese pts cardiovascular system pre-op?
- Signs of HTN, RV/LV hypertrophy and PHTN should be assessed
- assess venous access
- EKG
- CXR
- ECHO
- LV ejection fraction
- cardiac clearance if needed
- previous diet aids
How should you assess the endocrine/metabolic system of an obese pt pre-op?
- fasting blood sugar
- diabetes non-insulin or insulin dependent
- does the pt have a hx of reflux?
What pre-op labs do you want for an obese pt?
- liver function tests
- albumin level
- glucose
- consider clotting studies if they have risk factors
What should you consider in positioning of obese patient?
- Might need special designed table or 2 together
- careful when strapping pt
- Ramp up for intubation
- Protect pressure points- high incidence of pressure sores and nerve injuries
- consider using two armboards
- compression of vena cava when supine
- FRC and oxygenation is reduced when supine
How do you want the pt positioned when ramping?
Ear even with sternal notch
Can you use regional for an obese patient?
- Yes, use regional whenever possible
- best for pain control and decreases the incidence of post-op resp depression
- may be technically difficult- use longer needles and US
- requires 20% less LA
- epidural vascular engorgement and fatty infiltrates decrease volume in epidural space
Considerations for the GA of an obese patient regarding meds.
- Higher doses of Succ
- Des, sevo, and iso useful
- avoid nitrous d/t oxygen demands
- short acting opioids to minimize respiratory depression
- dexmedetomidine good
- profound muscle relaxation needed for laparoscopy
- vec, roc, cisatracurium
