Obesity pt2 Flashcards
Which herbals are pancreatic lipase inhibitors? (2)
Caffeine
Green Tea
How do ginseng, ephedra, and sunflower oil “treat” obesity?
Appetite suppression
What berry is an OTC herbal energy stimulant?
Acai berry
What OTC Herbals regulate lipid metabolism? (3)
- Soybean Oil
- Fish Oil
- Oolong tea
For patients taking a GLP-1 Agonist on a weekly basis, it is recommended to hold the dose for _____ prior to surgery.
1 week prior to surgery
How would a patient be treated if they forgot to hold their GLP-1 Agonist prior to surgery? (even without GI symptoms)
The patient is to be treated as a full stomach or gastric contents need to be evaluated by US.
In patients with existing sleep apnea, CPAP usage pressures of > ______ cmH₂O are associated with difficult mask ventilation.
10 cmH₂O
How does closing capacity compare to tidal breathing in the morbidly obese patient?
Closing capacity ≈ Tidal breathing
Especially when recumbent/supine.
What is the most important respiratory/ventilatory intervention that can be done for the obese patient prior to intubation?
adequately Preoxygenate.
What can possibly lead to renal failure when a morbidly obese patient is placed in the supine position?
Rhabdomyolysis of the gluteal muscles
Is prone or lateral decubitus positioning preferred in the obese patient?
Lateral decubitus
What oropharynx change occurs with obesity?
Oropharynx shape becomes elliptical w/ a short transverse and long AP axis.
Increased ________ ________ deposited into the airways can complicate airway management.
Increased Adipose tissue deposited
What is the relationship between degree of obesity and pharyngeal area?
Inverse relationship
More obese = Less pharyngeal area.
What predictors of difficult intubation are of particular importance in the obese patient? (5)
- BMI (though not all the time)
- Small mouth opening
- Large Teeth
- Limited neck mobility
- Retrognathia (recessed mandible)
What axes need to line up for intubation?
Laryngeal, Pharyngeal, and oropharyngeal
How quickly will a patient with a normal BMI typically desaturate from 100% to 90% SpO₂?
6 minutes
How quickly will a patient with a morbidly obese BMI desaturate from 100% to 90% SpO₂?
3 minutes or less
What is the best positioning on an OR table for recruitment in an obese patient?
- 30° Reverse Trendelenburg
- 25-30° with the head up
What measures should be take for alveolar recruitment to prevent atelectasis and desaturation in the obese patient? (4)
- CPAP 10 cmH₂O during preoxygenation
- Positioning (head up)
- Recruiting maneuvers then PEEP 10cm
- Mechanical ventilation after induction
Which drug classes have exaggerated responses in obese patients (particularly those with OSA)? (3)
- Opioids
- Benzo’s
- Propofol
Which opioids are preferred in obese OSA patients? What other drug may also be favored?
Short-acting Opioids
- Remifentanil
- Fentanyl
⍺₂ agonists (dexmedetomidine)
______ is not a favored volatile in obese patients due to their greater O₂ demand.
N₂O not favored volatile
What drug class (in general) will diminish ventilatory response to CO₂?
VAA’s
Initial dosing of drugs in obese patients should be based on ______ _______.
Initial dosing of drugs in obese patients should be based on Lipid solubility of the drug
Which common anesthetic drugs are dosed based on Ideal Body Weight (IBW)? (4) How does this affect the dose given?
- Propofol
- Vecuronium
- Rocuronium
- Remifentanil
often underdoses
Which common anesthetic drugs are dosed based on Total Body Weight (TBW)? (5)
- Midazolam
- Succinylcholine
- Cisatracurium
- Fentanyl
- Sufentanil
IV fluids requirements are ______ than what’s predicted in order to prevent acute tubular necrosis in the obese patient.
IV fluids requirements are greater than what’s predicted in order to prevent acute tubular necrosis in the obese patient.
What airway/ventilation abnormalities are most likely present with an obese patient? (5)
- ↓vital capacity
- ↓inspiratory capacity
- ↓expiratory reserve volume
- ↓functional residual capacity
- low compliance
What position likely causes compression of the IVC and aorta in an obese patient?
Supine position
What are the main benefits to utilizing regional anesthesia with an obese patient? (4)
- less airway manipulation
- fewer cardiopulmonary depressants
- decrease PONV risk
- better postop pain control
What should be considered when utilizing regional anesthesia in an obese patient? (3)
- longer needle, more difficult
- smaller doses (epidural space smaller/compressed)
- high rates of HoTN from compressed IVC/Ao
