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Principles II- Josh > Obesity PPT and Lecture notes > Flashcards

Obesity PPT and Lecture notes Flashcards

1
Q

what % of aduts are overweight or obese

A

65%

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2
Q

what % of pop are obese

A

30

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3
Q

Mortality is almost ___x’s greater in obese than non-obese

A

4

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4
Q

**** how to calculate IBW (KG)

A

Men- height(cm)-100
women- height (cm)- 105
* 1 inch = 2.54 cm**

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5
Q

calculate IBW for a 6 foot 1 inch man and a 4 foot 11 inch woman

A 
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
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6
Q

how many cm in an inch??/

A

2.54cm = 1 inch

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7
Q

** how to calculate BMI*

A

Weight (kg)/hgt (M^2)

recorded of kg/m2

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8
Q

how many inches in 1 meter

A

39.4

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9
Q

Calculate BMI for a 6’9” man who weight 300 lbs

A 
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!!!!!!!!
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10
Q 
BMI's
Overweight-
Obese-
extremly Obese-
Super obese-
super super obese-
A 
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
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11
Q

morbid obesity is calculated as what?

A

More than twice IBW

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12
Q

A&P of obesity head and neck with problems

A
  • large face and neck=OSA

- thick neck, redundant tissue in airway = difficult intbation

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13
Q

A&P of obesity mobility with problems

A

limited mobility= increased DJD/OA

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14
Q

A&P of obesity stomach with problems

A

full stomach = increased aspiration and GERD

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15
Q

A&P of obesity lungs with problems

A
  • decreased FRC, respiratory compliance and resistance, =increased hypoxemia and atelectasis
  • increased blood volume O2 consumption,CO2 build up = decreased total body water
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16
Q

what does excess body mass do to CV system

A
  • 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
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17
Q

what does excess body mass do to respiratory system in r/t -metabolic need of excess adipose and increased work of breathing

A
  • hypercapnia (CO2 retention)

- hypoxia (O2 consumption)

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18
Q

what does excess body mass do to the pulmonary system r/t restrictive lung disease

A

DECREASED FRC
DECREASED ERV
DECREASED TLC

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19
Q

clinical manifestations of obesity on CV

A 
HTN
cardiomegaly
CHF
CAD
Pulmonary HTN
CO2 increase
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20
Q

CO2 increases by how much for each kg of adipose tissue perfused

A

0.1L/min

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21
Q

clinical manifestations of obesity on Pulmonary system

A 
decreased lung volumes and capacities
arterial hypoxemia
decreased chest wall compliance
OHS-pickwickian syndrome (obesity hypoventilation syndrome)
OSA
22
Q

S/S of pickwickian syndrome (advanced OSA)

A
  • hypercapnia
  • polycythemia
  • right sided heart failure
  • resp acidosis
  • daytime solmnolence
  • hypoventilation
23
Q

clinical manifestations of obesity on liver

A
  • abnormal LFTs
  • fatty liver infiltration
  • cirrhosis
  • hepatomegaly
24
Q

clinical manifestations of obesity on endocrine/metabolic

A 
insulin resistance (DM)
hypercholesterolemia
25
Q

clinical manifestations of obesity on GI system

A
  • hiatal hernia
  • gastroesophageal reflux
  • gallstones
  • pancreatitis
26
Q

clinical manifestations of obesity on Pharmacology are caused by what changes

A 
Volume of distribution
protein binding
lipophilicity
increased blood volume
decreased total body water
increased CO2
27
Q

**what to remember about lipophilic drugs and obesity

A
  • require higher doses (prevent under dosage)

- 1st dose should be by TBW

28
Q

***** ex on lipophilic drugs

A

propofol
fentanyl
midazolam
succinycholine

29
Q

**** what to remember about water soluble drugs

A
  • require lower dosages (prevent over dosing)

- IBW for initial dose

30
Q

** ex of water soluble drugs

A

NMBD (VEC and ROC)

31
Q

*** Down and dirty basics of fat people and drugs***

A
  • –Fat liking drugs love fat people need more

- - water loving drugs hate fat people give less

32
Q

what to remember about SAB and epidural dosages of LA in fat people

A

doseages are 20-25% lower

33
Q

what should be included in your preop assessment for the fat ones
assessment

A 
-prior MI
HTN
Angina
PVD
exercise tolerance
34
Q

what should be included in your preop assessment for the fat ones.
things to considerr??

A 
CXR
ECG
PFTs
ABGs
Vascular access
35
Q

what should be included in your preop assessment for the fat ones
meds?

A

home meds

aspiration prophylaxis

36
Q

what should be included in your preop assessment for the fat ones
airway exam

A

TM
atlanto-occipital joints LROM
narrow airway?
redundant tissue?

37
Q

bc they are obese does that mean you’ll have a dissicult airway?

A

nope

38
Q

Anesthesia tech and procedure for the fat ones

preparation

A

airway equip
monitors
positioning
OR bed

39
Q

Anesthesia tech and procedure for the fat ones.

intraopertive (induction)

A
  • rapid decrease inPaO2 (preoxygenate good)
  • RSI
  • awake FOI
40
Q

Anesthesia tech and procedure for the fat ones

Anesthetic tech

A
  • GA
  • regional (tech difficult)
  • MAC
  • Local
  • extubate fully awake
41
Q

how should fat people be extubated

A

awake in sitting position

42
Q

Anesthesia tech and procedure for the fat ones

volume replacement

A

TBW 40% in severly obese (60-65% in normal)

  • EBV calculated using 45-55ml/kg rather than 70
  • avoid rapid rehydration
43
Q

Anesthesia tech and procedure for the fat ones

positioning and skin issues

A 
extra padding and skin protection
panniculus management (FUPA)
44
Q

how is EBV calculated in the obese

A

45-55 ml/kg

45
Q

Anesthesia tech and procedure for the fat ones

postop

A
  • simi sitting 45 degree
  • nasal airway
  • pulse ox
  • O2/CPAP
46
Q

Anesthesia tech and procedure for the fat ones

pain management

A 
Narcs
NSAIDS
PCA
(ALL per IBW)
b/c sensitive for respiratory depression
47
Q

postop problems associated with obesity

A

resp failure
DVT
PE
wound infection

48
Q

what to want to prepare for during induction with fat people?

A

difficult mask ventilation and intubation
rapid desaturation
airway collapse
(poss FOI, sugical airway)

49
Q

what to think about during maintenance with the obese pt r/t positioning

A

prone, lithotomy, and trend positions need higher FiO2

50
Q

what to watch during maintenance with the obese pt? and how can u correct it

A

ETCO2

-give large TV and PEEP

51
Q

what to think about during maintenance with the obese pt r/t emergence

A

Complete MR reversal

fully awake extubation

Principles II- Josh (17 decks)

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