Wk 1: Obesity 1-9 Flashcards Preview

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Flashcards in Wk 1: Obesity 1-9 Deck (13)
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1
Q

What is obesity? (definition)

A

BMI > 30kg/m2

A disorder of energy balance, associated c incr. morbidity & mortality and a variety of med/surg problems.

2
Q

How is BMI calculated?

A

BMI = weight (kg)/height2 (m2)

3
Q

Incidence of obesity in US?

A

65% overweight (adults)

30% obese (adults)

4
Q

Preoperative concerns for obese patient?

A
  • Assess: prior MI, HTN, Angina, PVD, exercise tolerance
  • Consider: CXR, ECG, PFTs, ABGs, Vascular Access
  • Meds: home medications, Aspiration Prophylaxis
  • Airway Exam: TM and atlanto-occipital joints lim. ROM, narrow airway, redundant tissue
  • Preparation: airway equipment, monitors, positioning, OR bed
5
Q

Intraop concerns for obese patients?

A
  • Rapid ↓ PaO2 (preoxygenate)
  • Consider: RSI, awake FOI; Initial drug doses based upon IBW
  • Anesthetic technique: GA, Regional (technically difficult), MAC, Local
  • Fully awake extubation in sitting position
  • Volume Replacement: TBW 40% in severely obese, (60-65% in nonobese)
  • EBV calculated using 45-55 mL/kg rather than 70 mL/kg as with nonobese
  • Avoid rapid rehydration
  • Positioning & Integumentary Issues: extra padding & skin protection, panniculus management
6
Q

Post-op concerns for obese patients?

A
  • Semisitting position (45 ˚ head up), Nasal Airway, Pulse Oximetry
  • Supplemental Oxygen, CPAP if OSA
  • Pain Management: Narcotics, NSAIDS, PCA (IBW dosing); greater sensitivity to respiratory depression
  • Problems: Respiratory failure, DVT, PE, wound infections
7
Q

Induction factors to consider c obese pts?

A

Prepare for difficult mask ventilation & intubation
Rapid desaturation, airway collapse
Consider awake FOI, surgical airway intervention (trach)

8
Q

Maintenance factors to consider c obese pts?

A

High FiO2- prone, Lithotomy, trendelenberg positions
Watch ETCO2
Careful positioning is necessary

9
Q

Emergence factors to consider c obese pts?

A

Complete MR reversal

Fully awake extubation

10
Q

How should an obese airway be examined?

A

Detailed assessment necessary:
Consider mask difficulty (fat faces, short neck, big ol’ tongue, redundant tissue, restricted mouth opening, large breasts…)

11
Q

Safest way to induce and maintain obese pt?

A

Aspiration risk: H2 blocker, PPI, nonparticulate antacids
Consider awake fiberoptic intubation.
PROPER POSITIONING

12
Q

Respiratory changes in morbidly obese pts?

A
Increased incidence of baseline lung disease – asthma, OSA, restrictive lung disease, pulmonary HTN, chronic hypoxia
↑ Work of breathing	
↓ Respiratory compliance
↓ Diaphragmatic excursion
↓ Functional Residual Capacity
↓ Expiratory Reserve Volume
↓ Total Lung Capacity
↑ Hypoventilation & atelectasis
13
Q

LMAs safe in obese pts?

A

Obese considered “full stomach”
Higher peak pressure needed to ventilate less compliant lung tissue

BUT LMAs are still an emergent Plan B!!!