Obesity PPT-Josh Flashcards
what is the WHO definition of BMI categories for obesity
- Overweight > or = 25
- Obese > 30
- Obese I : 30-34.9
- Obese II: 35-39.9
- Obese III: >40
what is the BMI calculation
BMI= KG / height in meters2
how to calculate IBW
- Women
- 100 + 5 lbs for each inch > 5 foot
- Or Cm- 105
- Men
- 105 + 6 lbs for each inch > 5 foot
- Or cm-100
fat deposition:
what are the two man shapes?
apple
Pear
fat deposition:
which one are you?
j/k that sucks I think I am both
fat deposition:
other name for Pear shape
Gynecoid
( how to remember-Think of a pear this is a divit (crease) in the bottom middle like a vagina AKA GYN)
fat deposition:
Another name for apple shape?
Android
(how to remember- Apples competition is the android)
fat deposition:
where is fat placed at w/ pear
hips more than waist
fat deposition:
where is fat placed for apple
waist more than hip
fat deposition:
which shape is considered better?
Pear
fat deposition:
the apple is often associated w/ what syndrome
Metabolic syndrome
Obesity:
Obesity can also be associated w/ certain d/o and conditions (besides just over eating) what are they?
- Cushings Syndrome (release of cortisol)
- Hypothyroid (underactive thyroid)
- Neurological disturbances ( hypothalamus damage as it regulates appetite)
- Drug induced (steroids, antipsychotics, antidepressants)
- Psychological (emotional eating)
what changes occur r/t to obesity to the Cranium
Benign Intracranial HTN
H/A dizziness
what changes occur r/t to obesity to the locomoter system
- weight related musculoskeletal d/o; arthritis
- Trapped nerves
- Gout
what changes occur r/t to obesity to GU system
- Kidney disease
- Uturine CA
- Prostate CA
- Pregnancy problems
- Stress incontinence
- Polycystic ovary disease
- Infertility
- ED
what changes occur r/t to obesity to the metabolic system
- NIDDM
- Dyslipidemia
- Impaired glucose tolerance
- raised uric acid (Gout)
what changes occur r/t to obesity to the neuropsychiatric system
- Macular degeneration
- Alzheimers
- Depression
what changes occur r/t obesity to the Vascular and CV system
- Stroke
- HTN
- CAD
- thrombosis
- HF
- Varicose veins
- Oedema
- A-Fib
- Arrhytmias
what changes occur r/t obesity to the GI system
- Gallstones
- Hiatus Hernia
- Colon CA
- Fatty liver (cirrhosis)
what changes occur r/t obesity to the respiratory system
- Breathlessness
- OSA
- Hypoventilation
*
what changes occur r/t obesity to other systems not previously mentioned
- Breast Ca
- Hirsuitism
- Sweating
- Sweat rashes
In what ways does obesity cause a potential problematic Airway
- IGD <3 cm
- short TMD
- limited head and neck extension
- Poor Mallampati
- Increased Body weight
- Short, thick necks
Obesity:
what are the 2 main complications in teh obese ot, r/t Oxygen
increased demand
Decreased supply
Obesity: Pulmonary
the increased demand (metabolic demands of “fat organs”) results in what 3 events
Increased demand
- Increase O2 consumption
- Increased CO2 production
- Increased Alveolar ventilation
Obesity: Pulmonary
the decreased supply of O2 (r/t abd and chest wall fat) causes what?
- decreased chest wall compliance
- decreased lung volumes
- decreased FRC
- premature airway closure
- V/Q mismatch
- Arterial Hypoxia
- Increased work of breathing
- decreased respiratory muscle efficiency
what is another name for Obesity Hypoventilation Syndrome?
Pickwickian syndrome
Pickwickian Syndrome:
what the fuck is its characteristics
- Hypercapnia
- Hypoxia
- Periodic breathing
- Excessive daytime sleepiness
- Snoring
Pickwickian Syndrome:
leads to strain on the hear that can cause what?
- Biventricular enlargement ( RT>LT)
- Dependent edema
- Polycythemia
- Pulmonary edema
- Cor Pulmonale
Pickwickian Syndrome:
what is the treatment
- best is weight loss
- next is CPAP
Obesity:
Morbidity and mortality are predominantly due to CV diseases, what are the main 3
- Ischemic heart disease
- HTN
- Cardiac failure
Obesity:
there is an increased CO of ____L/min for each KG of fat acquired
o.1L/min
Obesity:
is CHF associated w/ fatty infiltration of the myocardium due to obesity
NOPE
Obesity:
Preop
what questions should you ask for hx
- Duration of obesity
- Past MI, HTN, or pVD
- Excercise tolerance
- Orthopnea
- Paraxysmal nocturnal dyspnea
- Current meds
- Diet pills
Obesity:
PE
what do you wat to assess for
- Orthopnea
- Symptoms
- Assess airway
- ROM
Obesity:
Test
what test do you want preop on these fat assess
- CBC
- Urine
- LFT
- ECG
- ECHO
- ABG
- X-ray
*
Obesity:Airway
a neck circumference of > than ____ inches in men or ____ inches in women may indicates undiagnosed OSA
men 17
Women 16
Obesity:Airway
what problems may you run into
- diff mask ventilation ( big cheeks, short neck, restrictions in mouth opening, Limited cervical and mandible movements)
- ETT placement more difficult (excessive palatal and pharyngeal soft tissue
- De-sat quick
- Ventilatory depressent drugs cause faster de-sat
- OHS (AKA OSA)
Obesity: Pharmacology
lipophilic drugs have what effect
- Larger Vd and thus longer elimination 1/2 life (hang around longer)
(i like to thinks of these drugs as black men.. They love fat, thus They marry our fat white chicks and HANG around them longer)
Obesity: Pharmacology
Certain liphophilic drugs are exceptions and have normal Vd, what are a few of them
remifentanil
Digoxin
procainamide
Obesity: Pharmacology
most routine anesthestic drugs listed require an initial bolus on TBW, but maintence dosing is based upon what?
Benzos
Barbs
Narcs
Fenanyl
IBW
Obesity: Pharmacology
paralytics such as roc and vec are dosed according to what?
IBW
Obesity: Pharmacology
how is Unfractionized heparin, enoxaprain, and vancomycin dosed
TBW
Obesity: Intraop
Monitors and getting ready.. what to you wanna do
- Standard monitors
- Venous access (no shit)
- PREOXYGENATE 3-5 min
- Poss AFOI
- Cricord pressure
Obesity: Intraop
effects on CV
the degree of cardiac abnormality is correlated w/ the degree of obesity: what are usual CV symptoms we must be midfull of
- LV dysfucntion
- HTN
- Increased pre-load/afterload
- Increased PAP
Obesity: Intraop
effects on Pulmonary
the degree of pulmonary abnormality is correlated w/ the degree of obesity: what are usual Pulmonary symptoms we must be midfull of
- Increased O2 consuption and CO2 production
- Increased Work of breathing
- Decreased chest wall compliance
- Anesthesia leads to a 50% decrease in FRC (in normal pt’s only leads to a 20% decrease)
Obesity: Intraop management
what is the prefered mode of ventilation
controlled ventilation w/ LARGE Tv
Obesity: Intraop management
what is a big pro and con of PEEP with fatties
- May improve Oxygenation, but associated w/ decrease in CO
Obesity: Postop management
if extubating on table what position should you consider?
reverse trend (head up)
Obesity: Postop management
before the pt is “light” what type of airway is good to use
nasal
Obesity: Postop management
during extubation adequate pain control is often accompied w/ fuller deeper breaths, but narcs can hinder this in fatties, what is a better choice
ofirmev
Obesity: Postop management
post intubation what is a good position for them
head up 30 degress and lateral decubitus
Thats it a special thanks goes out to Sam Tim
whatever were done,
