OSA

Question 1

Name the BMI classification

Answer 1

Normal 18.5 to < 25
Overweight 25 to <30 
Obese class 1: 30 to < 35 
Obese class 2: 35 to < 40
Obese class 3: 40 to < 50 
Super obese > 50

Question 2

How do you identify those with OSA

Answer 2

STOP-BANG CRITERIA

• snoring
• daytime tiredness
• observed apnea
• high blood Pressure
• BMI > 35
• Age > 50
• neck circumference > 40 cm
• gender (male)

Under 3 low risk
3 or more high risk
5 - 8 high probability mod to severe OSA

Question 3

List the dosing (IBW vs TBW for drugs):

• propofol
• pentothal
• midazolam
• sux
• vec/ roc
• cisatracurium
• fentanyl / sufentanil
• remifentanil

Answer 3

• propofol: induction IBW / maintenance TBW
• pentothal induction TBW/ maintenance TBW
• midazolam induction TBW/ maintenance TBW
• sux induction TBW/ maintenance TBW
• vec/ roc induction IBW / maintenance IBW
• cisatracurium induction TBW/ maintenance TBW
• fentanyl / sufentanil induction TBW/ maintenance IBW
• remifentanil induction IBW / maintenance IBW

Question 4

how do you calculate Ideal BW?

Answer 4

Males
50kg + 2.3 kg/in over 5 ft
45.5 kg + 2.3kg/in over 5ft

Question 5

Narcan half life for IV, IM admin

morphine half life

Answer 5

IV narcan 1/2 life 30 - 60 min
IM narcan 1/2 life 80mins - 6hrs
morphine 1/2 life 2- 3 hrs

Question 6

Your asthmatic OSA patient has O2 sat 80s in PACU. What are potential causes?

Answer 6

(1) consider airway obstruction from OSA
(2) bronchospasm
(3) respiratory dep 2/2 narcosis (increased sensitivity with OSA)
(4) aspiration (hypoxia 2/2 edema, atelectasis, bronchospasm)
(5) atelectasis with shunting
(6) PE, more common in morbidly obese

Question 7

Intra-op your asthmatic, morbidly obese patient has O2 Sat drop to high 80s, what do you do?

Answer 7

(1) 100% O2
(2) hand ventilate
(3) auscultate
(4) ensure proper ETT placement
(5) airway pressures
(6) check circuit / machine
(7) reverse Tberg patient
(8) B2 agonist
(9) increases PEEP