Obesity PPT and Lecture notes Flashcards
what % of aduts are overweight or obese
65%
what % of pop are obese
30
Mortality is almost ___x’s greater in obese than non-obese
4
**** how to calculate IBW (KG)
Men- height(cm)-100
women- height (cm)- 105
* 1 inch = 2.54 cm**
calculate IBW for a 6 foot 1 inch man and a 4 foot 11 inch woman
MAN: 6'1"= 73 inches= 182.88cm 182.88cm-100= 82.88kg 82.88kg= 182.336 lbs Woman: 4'11"=59 inches= 149.86cm 149.86cm-105=44.86kg=98.69lbs
how many cm in an inch??/
2.54cm = 1 inch
** how to calculate BMI*
Weight (kg)/hgt (M^2)
recorded of kg/m2
how many inches in 1 meter
39.4
Calculate BMI for a 6’9” man who weight 300 lbs
ht/m^2 HGT- 6'9'=81 inches x 0.0254=2.0574m 2.0575^2=4.23289476m^2 WGT-300=136.363636363636 BMI=136.36/4.2328947=32.21 BMI=32.21 damn!!!!!!!!
BMI's Overweight- Obese- extremly Obese- Super obese- super super obese-
Overweight- BMI > or = to 25 Obese- BMI > or = to 30 extremly Obese- BMI > or = to 40 Super obese- BMI > or = to 50 super super obese- BMI> or = to 60
morbid obesity is calculated as what?
More than twice IBW
A&P of obesity head and neck with problems
- large face and neck=OSA
- thick neck, redundant tissue in airway = difficult intbation
A&P of obesity mobility with problems
limited mobility= increased DJD/OA
A&P of obesity stomach with problems
full stomach = increased aspiration and GERD
A&P of obesity lungs with problems
- decreased FRC, respiratory compliance and resistance, =increased hypoxemia and atelectasis
- increased blood volume O2 consumption,CO2 build up = decreased total body water
what does excess body mass do to CV system
- INCREASED metabolic demand and workload
- INCREASED O2 consumption
- INCREASED CO2 (chronic),
- LVH
- INCREASED SV
- cardiomegaly
- HTN
- CHF
- INCREASED Pulmonary blood flow and hypoxic pulmonary constriction
- Pulm HTN,
- COR pulmonale
- Right Heart failure
what does excess body mass do to respiratory system in r/t -metabolic need of excess adipose and increased work of breathing
- hypercapnia (CO2 retention)
- hypoxia (O2 consumption)
what does excess body mass do to the pulmonary system r/t restrictive lung disease
DECREASED FRC
DECREASED ERV
DECREASED TLC
clinical manifestations of obesity on CV
HTN cardiomegaly CHF CAD Pulmonary HTN CO2 increase
CO2 increases by how much for each kg of adipose tissue perfused
0.1L/min
clinical manifestations of obesity on Pulmonary system
decreased lung volumes and capacities arterial hypoxemia decreased chest wall compliance OHS-pickwickian syndrome (obesity hypoventilation syndrome) OSA
S/S of pickwickian syndrome (advanced OSA)
- hypercapnia
- polycythemia
- right sided heart failure
- resp acidosis
- daytime solmnolence
- hypoventilation
clinical manifestations of obesity on liver
- abnormal LFTs
- fatty liver infiltration
- cirrhosis
- hepatomegaly
clinical manifestations of obesity on endocrine/metabolic
insulin resistance (DM) hypercholesterolemia
clinical manifestations of obesity on GI system
- hiatal hernia
- gastroesophageal reflux
- gallstones
- pancreatitis
clinical manifestations of obesity on Pharmacology are caused by what changes
Volume of distribution protein binding lipophilicity increased blood volume decreased total body water increased CO2
**what to remember about lipophilic drugs and obesity
- require higher doses (prevent under dosage)
- 1st dose should be by TBW
***** ex on lipophilic drugs
propofol
fentanyl
midazolam
succinycholine
**** what to remember about water soluble drugs
- require lower dosages (prevent over dosing)
- IBW for initial dose
** ex of water soluble drugs
NMBD (VEC and ROC)
*** Down and dirty basics of fat people and drugs***
- –Fat liking drugs love fat people need more
- - water loving drugs hate fat people give less
what to remember about SAB and epidural dosages of LA in fat people
doseages are 20-25% lower
what should be included in your preop assessment for the fat ones
assessment
-prior MI HTN Angina PVD exercise tolerance
what should be included in your preop assessment for the fat ones.
things to considerr??
CXR ECG PFTs ABGs Vascular access
what should be included in your preop assessment for the fat ones
meds?
home meds
aspiration prophylaxis
what should be included in your preop assessment for the fat ones
airway exam
TM
atlanto-occipital joints LROM
narrow airway?
redundant tissue?
bc they are obese does that mean you’ll have a dissicult airway?
nope
Anesthesia tech and procedure for the fat ones
preparation
airway equip
monitors
positioning
OR bed
Anesthesia tech and procedure for the fat ones.
intraopertive (induction)
- rapid decrease inPaO2 (preoxygenate good)
- RSI
- awake FOI
Anesthesia tech and procedure for the fat ones
Anesthetic tech
- GA
- regional (tech difficult)
- MAC
- Local
- extubate fully awake
how should fat people be extubated
awake in sitting position
Anesthesia tech and procedure for the fat ones
volume replacement
TBW 40% in severly obese (60-65% in normal)
- EBV calculated using 45-55ml/kg rather than 70
- avoid rapid rehydration
Anesthesia tech and procedure for the fat ones
positioning and skin issues
extra padding and skin protection panniculus management (FUPA)
how is EBV calculated in the obese
45-55 ml/kg
Anesthesia tech and procedure for the fat ones
postop
- simi sitting 45 degree
- nasal airway
- pulse ox
- O2/CPAP
Anesthesia tech and procedure for the fat ones
pain management
Narcs NSAIDS PCA (ALL per IBW) b/c sensitive for respiratory depression
postop problems associated with obesity
resp failure
DVT
PE
wound infection
what to want to prepare for during induction with fat people?
difficult mask ventilation and intubation
rapid desaturation
airway collapse
(poss FOI, sugical airway)
what to think about during maintenance with the obese pt r/t positioning
prone, lithotomy, and trend positions need higher FiO2
what to watch during maintenance with the obese pt? and how can u correct it
ETCO2
-give large TV and PEEP
what to think about during maintenance with the obese pt r/t emergence
Complete MR reversal
fully awake extubation
