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11 Cards in this Set
- Front
- Back
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What is the percentage of adult that is obese in the world?
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7%
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Central obesity is associated with?
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NIDDM, dyslipidaemia and cardiovascular disease
Men 94 cm >102 cm Women 80 cm > 88 cm |
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Respiratory effects
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5% of morbidly obese will have OSA
Especially those with large collar size > 40 cm |
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Complications of OSA
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Daytime somnolence
Pulmonary and systemic vasoconstriction Polycythaemia Right ventricular failure and cor-pulmonale |
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Obesity Implications Classification
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Anaesthetic: ABC, GI, MSK, Endocrine
Pharmacological Surgical |
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Obesity Anaesthetic physiological implication
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Airway
1. Mask ventilation and direct laryngoscopy a. Short fat necks b. Bulk of tissues in the upper airway: obstruct easily 2. Large breast: a. Interfere with laryngoscopy Breathing/Ventilation 1. Increased metabolic rate: increased oxygen consumption 2. Reduced chest compliance 3. Reduced FRC: displacement of diaphragm 4. Closing capacity encroach on FRC a. All increase V/Q mismatch b. Hypoxia Circulation 1. Comorbidities a. HTN, IHD, Cardiomyopathies, cardiac failure, arrhythmia, sudden cardiac death, dyslipidaemia 2. Increased absolute blood volume 3. Increased cardiac output a. Increase cardiac work and left ventricular hypertrophy can result b. With Comorbidities: prone to hypoxia, tachycardia and biventricular strain 4. Venous return reduced a. Abdomen compress venous return from legs b. Increased DVT and PE c. Higher PEEP also reduce venous return 5. DVT risk increased Polycythaemia, CCF, decreased fibrinolysis, immobilisation 6. Difficult IV access |
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Obesity GI changes
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1. Volume and acid of gastric content is often increased
2. Increased aspiration 3. Hepatic impairment 4. Gallstones 5. Abdominal hernia |
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Obesity Endocrine changes
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1. Increased T2DM
2. Insulin resistance 3. Hypercholesterolaemia 4. Hypothyroidism |
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Obesity MSK Changes
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1. Gout
2. Osteoarthritis 3. Back pain |
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Pharmacokinetic
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Distribution
1. Increased volume of distribution for fat soluble drugs a. Higher dose may be required e.g. thiopentone b. Reduced elimination due to slow distribution from fat compartment Metabolism 1. Up regulation of enzymes 2. Down regulation of enzymes Regional 1. Difficult landmarks: increased technical difficulty a. Increased movement of the skin and need for longer needle b. Increased failure rate 2. Central neuraxial block a. Engorged extradural veins and fat: constricting the potential space b. 75-80% of normal dose may be suffice |
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Obesity Surgical Implications
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1. Technically more difficult
a. Difficult access b. Difficult to visualise structure and bleeding 2. Longer operating times 3. Higher infection rate and wound dehiscence 4. Impaired immune system due to neurohumeral factors 5. Limit of operating table a. Limit weight b. Limit tilting and moving function 6. Increased pressure sores |
