Obesity pt2

Question 1

Which herbals are pancreatic lipase inhibitors? (2)

Answer 1

Caffeine
Green Tea

Question 2

How do ginseng, ephedra, and sunflower oil “treat” obesity?

Answer 2

Appetite suppression

Question 3

What berry is an OTC herbal energy stimulant?

Answer 3

Acai berry

Question 4

What OTC Herbals regulate lipid metabolism? (3)

Answer 4

• Soybean Oil
• Fish Oil
• Oolong tea

Question 5

For patients taking a GLP-1 Agonist on a weekly basis, it is recommended to hold the dose for _____ prior to surgery.

Answer 5

1 week prior to surgery

Question 6

How would a patient be treated if they forgot to hold their GLP-1 Agonist prior to surgery? (even without GI symptoms)

Answer 6

The patient is to be treated as a full stomach or gastric contents need to be evaluated by US.

Question 7

In patients with existing sleep apnea, CPAP usage pressures of > ______ cmH₂O are associated with difficult mask ventilation.

Answer 7

10 cmH₂O

Question 8

How does closing capacity compare to tidal breathing in the morbidly obese patient?

Answer 8

Closing capacity ≈ Tidal breathing

Especially when recumbent/supine.

Question 9

What is the most important respiratory/ventilatory intervention that can be done for the obese patient prior to intubation?

Answer 9

adequately Preoxygenate.

Question 10

What can possibly lead to renal failure when a morbidly obese patient is placed in the supine position?

Answer 10

Rhabdomyolysis of the gluteal muscles

Question 11

Is prone or lateral decubitus positioning preferred in the obese patient?

Answer 11

Lateral decubitus

Question 12

What oropharynx change occurs with obesity?

Answer 12

Oropharynx shape becomes elliptical w/ a short transverse and long AP axis.

Question 13

Increased ________ ________ deposited into the airways can complicate airway management.

Answer 13

Increased Adipose tissue deposited

Question 14

What is the relationship between degree of obesity and pharyngeal area?

Answer 14

Inverse relationship

More obese = Less pharyngeal area.

Question 15

What predictors of difficult intubation are of particular importance in the obese patient? (5)

Answer 15

• BMI (though not all the time)
• Small mouth opening
• Large Teeth
• Limited neck mobility
• Retrognathia (recessed mandible)

Question 16

What axes need to line up for intubation?

Answer 16

Laryngeal, Pharyngeal, and oropharyngeal

Question 17

How quickly will a patient with a normal BMI typically desaturate from 100% to 90% SpO₂?

Answer 17

6 minutes

Question 18

How quickly will a patient with a morbidly obese BMI desaturate from 100% to 90% SpO₂?

Answer 18

3 minutes or less

Question 19

What is the best positioning on an OR table for recruitment in an obese patient?

Answer 19

1. 30° Reverse Trendelenburg
2. 25-30° with the head up

Question 20

What measures should be take for alveolar recruitment to prevent atelectasis and desaturation in the obese patient? (4)

Answer 20

1. CPAP 10 cmH₂O during preoxygenation
2. Positioning (head up)
3. Recruiting maneuvers then PEEP 10cm
4. Mechanical ventilation after induction

Question 21

Which drug classes have exaggerated responses in obese patients (particularly those with OSA)? (3)

Answer 21

• Opioids
• Benzo’s
• Propofol

Question 22

Which opioids are preferred in obese OSA patients? What other drug may also be favored?

Answer 22

Short-acting Opioids

• Remifentanil
• Fentanyl

⍺₂ agonists (dexmedetomidine)

Question 23

______ is not a favored volatile in obese patients due to their greater O₂ demand.

Answer 23

N₂O not favored volatile

Question 24

What drug class (in general) will diminish ventilatory response to CO₂?

Answer 24

VAA’s

Question 25

Initial dosing of drugs in obese patients should be based on ______ _______.

Answer 25

Initial dosing of drugs in obese patients should be based on **Lipid solubility** of the drug

Question 26

Which common anesthetic drugs are dosed based on Ideal Body Weight (IBW)? (4) How does this affect the dose given?

Answer 26

- Propofol - Vecuronium - Rocuronium - Remifentanil *often underdoses*

Question 27

Which common anesthetic drugs are dosed based on Total Body Weight (TBW)? (5)

Answer 27

- Midazolam - Succinylcholine - Cisatracurium - Fentanyl - Sufentanil

Question 28

IV fluids requirements are ______ than what's predicted in order to prevent acute tubular necrosis in the obese patient.

Answer 28

IV fluids requirements are **greater** than what's predicted in order to prevent acute tubular necrosis in the obese patient.

Question 29

What airway/ventilation abnormalities are most likely present with an obese patient? (5)

Answer 29

* ↓vital capacity * ↓inspiratory capacity * ↓expiratory reserve volume * ↓functional residual capacity * low compliance

Question 30

What position likely causes compression of the IVC and aorta in an obese patient?

Answer 30

Supine position

Question 31

What are the main benefits to utilizing regional anesthesia with an obese patient? (4)

Answer 31

* less airway manipulation * fewer cardiopulmonary depressants * decrease PONV risk * better postop pain control

Question 32

What should be considered when utilizing regional anesthesia in an obese patient? (3)

Answer 32

* longer needle, more difficult * smaller doses (epidural space smaller/compressed) * high rates of HoTN from compressed IVC/Ao