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159 Cards in this Set
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- 3rd side (hint)
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obesity is a disorder of what
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energy balance
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with obesity how is net energy intake related to net energy expenditure
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net energy intake EXCEEDS net energy expenditure over a prolonged period of time
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resting metabolic rate is what amt of total expenditure of energy
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60%
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exercise can increase metabolism for how long following exercise
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18 hrs
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exercise is what type of activity
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THERMIC
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what is the BMI for HEALTHY weight
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>18.5 to < 25 kg/m2
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what is the BMI for OVERWEIGHT
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25 to 29.9 kg/m2
-body wt up to 20% above ideal body wt |
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what is the BMI for OBESE
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> 30 kg/m2
-body wt > 20% above ideal body wt |
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what is BMI for MOBIDLY OBESE
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> 40 kg/m2
-body wt more than 2x ideal body wt |
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a BMI of what = 3-4 x higher risk of morbidity including higher risk of stroke, ischemic heart dz and DM
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> 28
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what is the formula for BMI
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BMI = wt (kg)
---------- ht2 (m) |
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factors in the disease of obesity include what
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*mechanisms of fat storage
*genetic *psychological |
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what are the features of metabolic syndrome
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*abd obesity (key feature)
*atherogenic dyslipidemia *elevated BP *insulin resistance w/ or w/o glucose intolerance *proinflammatory state *pro-thrombotic state |
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what are the criteria for dx metabolic syndrome
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*abd obesity
*triglycerides *HDL cholesterol *BP *fasting glucose |
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in the dx of metabolic syndrome when looking at abd obesity as a diagnostic criteria what must waist circumference be in men
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> 102 cm
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in the dx of metabolic syndrome when looking at abd obesity as a diagnostic criteria what must waist circumference be in women
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> 88cm
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in the dx of metabolic syndrome when looking at triglycerides as a diagnostic criteria what must they be
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> 150
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in the dx of metabolic syndrome when looking at HDL as a diagnostic criteria what must it be in men
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< 40
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in the dx of metabolic syndrome when looking at HDL as a diagnostic criteria what must it be in women
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< 50
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in the dx of metabolic syndrome when looking at BP as a diagnostic criteria what must it be
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>/= 130/85
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in the dx of metabolic syndrome when looking at fasting glucose as a diagnostic criteria what must it be
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>/= 110
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surplus calories are converted to what and stored how
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*converted to triglycerides
*stored in adipocytes |
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storage of surplus calories is regulated how
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by the enzyme lipoprotein lipase
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lipoprotein lipase is active in what kind of fat
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ADBOMINAL fat
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lipoprotein lipase is LESS active where
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*hips
*buttocks *thighs |
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there is increased M&M associated with what kind of fat distribution secondary to it being more metabolically active
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*central/android
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which fat distribution is more metabolically active central/android or peripheral/gynecoid
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CENTRAL/ANDROID
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what are the tx modalities for obesity
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*diet and behavorial modification
*pharmacotherapy *sx treatment |
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what are the types of surgical tx for obesity
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*restrictive
*malabsorptive *combination of restrictive and malabsorptive |
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what is the most utilized sx tech for obesity
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ROUX-EN-Y GASTRIC BYPASS
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what type of sx treatment is roux-en-y gastric bypass
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combination restrictive malabsorptive procedure
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roux-en-y gastric bypass is via what sx approach
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LAPROSCOPIC
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what is done with a roux-en-y gastric bypass
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*proximal gastric pouch is formed from stomach-approx 15-30 ml in volume
*pouch is anastomsed to the proximal jejunum |
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the roux-en-y gastric bypasses what
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all of the stomach and the entire deudoneum
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what is done with an adjustable gastric band
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adjustable inflatable ring placed completly around the proximal portion of the stomach (forms an hourglass)
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how does adjustable gastric band lead to weight loss
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restricts oral intake
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what sx approach is used for adjustable gastic band
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LAPROSCOPIC
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obesity has significant effects on what body systems
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*respiratory
*CV |
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what effects does obesity have on the RESPIRATORY system in general
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*obesity hypoventilation syndrome
*effects on lung volumes and gas exchange |
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what effects does obesity have on the CV system in general
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*ischemic heart dz
*systemic HTN *CHF |
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why do pts with obesity often appear asymptomatic pre-op
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d/t limited mobility
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with pts with obesity physical activity may cause what
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*exertional dyspnea
*angina pectoris |
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pts with obesity may sleep sitting up to avoid what
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*orthopnea
*PND |
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who is the "typical" obstructive sleep apnea pt
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male and obese
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what are conditions that may pre-dispose the airway to narrowing or collapse in the non-obese pt with obstructive sleep apnea
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*tonsillar hypertrophy
*craniofacial abnormalities (retrognathia) |
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what is the definition of sleep apnea
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*apnea for 10 sec of more
*apnea 5 x per hour of sleep |
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sleep apnea is what kind of airway collapse
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UPPER airway
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with sleep apnea there is loss of what kind of muscle activity
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loss of compensatory dilating muscle activity of the pharyngeal dilators
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with sleep apnea there is what kind neurological effect
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loss of neurological control of the upper airway
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with sleep apnea airway collapse leads to what
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repetitive apneic episodes that lead to arousal
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sleep apnea is assoiated with what kind of pathophysiological changes
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*hypoxemia
*bradycardia *arousals *fragmented sleep |
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what are the risk factors for obstructive sleep apnea
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*family hx
*GERD *habitual snoring *male gender *obesity *middle age *evening ETOH consumption *drug-induced sleep |
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what are the initial dx of sleep apnea
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*loud snoring, witnessed apnea, morning HA, neurobehavioral alterations
*daytime somnolence, fatigue, disrupted psychomotor vigilance *large neck size |
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with sleep apnea large neck size for initial dx for female means a neck size of what
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> 15 "
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with sleep apnea large neck size for initial dx for male means a neck size of what
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> 17 "
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what are the DEFINITIVE dx for sleep apnea
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*polysonography in sleep lab
* MRI |
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measures resp distress index greater than what = higher mortality rate
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> 20
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with MRI for definitive dx of sleep apnea what will be seen
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increased deposition of adipose tissue in the collapsible portion of the pharynx
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what are the NON-SURGICAL tx for sleep apnea
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*CPAP
*oral appliances *sleep hygeine *nocturnal o2 therapy *weight reduction |
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裤子
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pants
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kùzi
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uvulopalatopharyngoplasty is perfomed in what sx position
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SUPINE
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with a uvulopalatpharyngoplasty the head is elevated slightly why
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to promote venous drainage
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with a uvulopalatopharyngoplasty the use of what type of LA is likely
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LA with epi
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with a uvulopalatopharyngoplasty post-op what should be watched for
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acute airway obstruction
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what things should be done post-op for a uvulopalatopharyngoplasty
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*leave NASOpharyngeal airway in place
*use CPAP and 02 *monitor ventilation for 24 hrs *toradol for analgesia |
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maxillomandibular osteotomy and advancement have poor mallampati classifications why
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*macroglossia (big tongue)
*base of tongue hypertrophy *mandibular retrognathia (receeding chin) |
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what type of blade is needed for an obese pt
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MAC 4
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what is the key to intubating an obese pt
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proper positioning
(blanket stacking, troop elevation pillow) |
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most morbidly obese pts have what kind of pulm reserve
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POOR
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what may limit ability to ventilate obese pts
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airway collapse (short, fat neck)
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what type of airway management is mandatory for sx that involve the base of the tongue
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trach
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what type of tube should be used for mandibular and maxillomandibular sx to prevent occlusion of the teeth
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cuffed armored NASOtracheal tube
(dont want oral tube) |
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obese pts have what kind of response to CNS depressants
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SENSITIVE to all
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min dosages of CNS depressants may cause what in the obese pt
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apnea and airway collapse
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for indution and maintenance of anesthesia use what type of agents for the obese pt
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short acting agents
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though N2O has the lowest fat/blood partition coefficient it is not the best choice in the obese pt why
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*causes pulm HTN
*decreased O2% |
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what NMB are used with obese pts
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*succ
*mivacurium |
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with the obese pt do not extubate until
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*pt is fully awake
*pt has intact upper airway reflexes *pt is in high fowlers position *pt is in monitored environment |
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in the post-op management of the obese pt what is the greatest risk
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arterial hypoxemia
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with arterial hypoxemia in the post-op management of the obese pt when is it seen
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*1st within 24 hrs
*then 2-5 days pos-op |
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with the post-op management of arterial hypoxemia of the obese pt the use of o2 is controversial why
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could increase the duration of apnea by decreasing arousal effect
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with post-op pain control the obese pt is very sensitive to what
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OPIOIDS
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with post-op pain control and the obese pt what type of pain control is IDEAL
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REGIONAL
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regarding post-op pain control and the obese pt what type of pain control method is typically used
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NSAIDs
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what is the IV loading dose of toradol
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15-30 mg
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what is the onset of toradol
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~ 30 min
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what is the peak of toradol
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1-2 hrs
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what is the DOA of toradol
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4-6 hrs
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toradol can't be used longer than how long
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5 days
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toradol is CONTRAindicated when
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*GI bleed
*cerebral bleed *renal failure *peptic ulcer |
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why is toradol NOT used in L&D
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b/c of adverse effects on fetal circulation and fetal muscle contraction
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what is a long term sequalae of obstructive sleep apnea
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obesity hypoventilation syndrome (OHS)
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with obstructive sleep apnea there are or are not resp efforts during apnea
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ARE
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with obesity hypoventilation syndrome there are or are not resp efforts during apnea
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are NOT
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with obstructive hypoventilatin syndrome there is what response to hypercarbia
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progressive desensitization
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obesity hypoventilation syndrome culminates when
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in pickwikian syndrome
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what are the characteristics of pickwickian syndrome
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*obesity
*daytime hypersomonolence *arterial hypoxemia *polycythemia *hypercarbia *resp acidosis *pulm HTN *R vent failure |
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obesity compromises lung volumes causing what kind of defect
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RESTRICTIVE
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with obesity there is imedence of the diaphragm by what
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abd wt
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what position should you be aware of with obesity concerning lung volumes
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SUPINE
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with obesity what occurs with FRC, ERV and total lung capacity
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they are DECREASED
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why is there small airway closure in obesity
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d/t declining FRC with increased BMI
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small airyway closure in obesity causes what to occur
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*VQ mismatches
*R to L shunt *arterial hypoxemia |
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anesthesia may cause what amt of decrease in FRC in the obsese pt
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50%
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anesthesia causes what amt of decrease in FRC in the non-obese pt
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20%
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normally obese pt have what kind of change in arterial oxygenation
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modest decrease
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with induction of the obese pt arterial oxygenation may change how
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may decrease dramatically
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d/t the changes seen with arterial oxygenation with induction and the obese pt what needs to be done
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they will need high o2 concentration
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what is PaCo2 and ventilatory response to PaCo2 like in the obese pt
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they are normal
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increasing BMI leads to what kind of change in resp compliance and resistance
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DECREASES
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with the obese pt you will see what kind of breathing pattern
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rapid, shallow pattern of breathing
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with the obese pt you will see what kind of work of breathing
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increased work of breathing
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what amt of obese pts have mild to moderate HTN
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50-60%
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why do obese pts have HTN
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increased extracellular volume causes hypervolemia & increased CO
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each kg of fat contains how many meters of blood vessels
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3,000
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each kg of wt gained increases CO how
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by 0.1 L/min
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cardiomegaly and HTN in the obese pt probably reflect what
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increased CO
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cardiac dysrhythmias in the obese pt are precipiated by what
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*arterial hypoxemia
*hypercarbia *ischemic heart dz *obese hypoventilation syndrome *fatty infiltrates of cardiac conduction system |
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ischemic heart dz is common in the obese pt with what kind of fat distribution
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CENTRAL
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HTN in the obese pt causes what to occur
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*L vent hypertrophy
*increasingly non-compliant L vent |
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what increases the risk for CHF in the obese pt
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HTN causing L vent hypertrophy + an increasingly non-compliant L vent + hypervolemia
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obesity does what to cardiac reserve
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DECREASES it
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obesity does what to exercise tolerance
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LIMITS IT
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what kind of fat is common with obesity and CHF
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EPICARDIAL
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the incidence of DM is what in the obese
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7x greater
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what tissues are insulin resistant in obesity
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PERIPHERAL
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NIDDM may require what kind of tx with the catabolic stress of sx
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INSULIN
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regarding hepatobiliary dz and the obese what are frequent findings
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*abnormal liver fxn tests
*fatty infiltrates of the liver |
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is there evidence of exaggerated inhalation agent induced hepatic dysfunction in the obese
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NO
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the obese have what incidence of gallbladder and biliary tract disease
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3x greater
(d/t abnormal cholesterol metabolism) |
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what type of incidence do the obese have for DVT
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2 x greater risk
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why do the obese have a greater risk for DVT
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*polycythemia
*increased abd pressure *immobilzation |
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what is the prevention of thromboembolic dz in the obese pt
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*compression devices
-sequentional or compression devices *pharmacological prophylaxis -anticoagulants |
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for anticoagulant dosing for thromboembolic dz prevention should the dosing be based on lean body wt or total body wt
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TOTAL body wt
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when should compression devices be placed on the pt for thromboembolic dz prevention
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BEFORE induction
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what cancers are more common in obese MEN
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*stomach
*prostate |
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what cancers are more common in obese WOMEN
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*breast
*uterus *cervix *ovaries |
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what cancers are common in both obese men and women
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*esophagus
*colon and rectum *liver *gallbladder *pancreas *kidney |
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what changes regarding the pharmacokinetics of drugs in the obese
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*volume of distribution is altered
*delayed hepatic clearance *INCREASED renal elimination |
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with dosing of drugs with the obese you should base the INITIAL dose on what
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IDEAL body wt
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using ideal body wt dosing the ideal body wt for FEMALES is what
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80 kg
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using ideal body wt dosin the ideal body wt for MALES is what
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100 kg
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recovery times are what for obese and non-obese pts in 2-4 hr sxs
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SIMILAR
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with management of anesthesia pre-op assessment of what is critical
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upper airway
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with induction and the obestpt a low FRC means what
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*decreased PaO2 during laryngoscopy
*rapid onset of inhalation agents (rapid induction) |
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with induction of the obese pt it is important to do what before laryngoscopy
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maximize o2 content in lungs
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what agents for the maintenance of anesthesia of the obese pt produce quicker wake up times than isoflurane or propofol
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*sevoflurane
*desflurane |
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spinal and epidural anesthesia are technically difficult in the obese pt why
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b/c bony landmarks are obscured
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in the obese pt with epidural and spinal anesthesia engorgement caused by increased abd pressure does what
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makes
*the need for the LA dose to 20% lower *sensory level difficult to predict |
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with the management of ventilation in the obese pt what needs to be done to offset decreased FRC and PaO2
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give large TV
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what are sx positions in the obese pt that will decrease chest wall compliance and oxygenation
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*prone
*trendelenburg |
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regarding the management of ventilation in the obese pt- with a spontaneously breathing pt the supine position may do what
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decrease PaO2 sufficiently do cause cardiac arrest
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with post-op analgesia and the obese pt what is a major concern
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depression of resp
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what route of pain med admin is UNRELIABLE in the post-op analgesia management of the obese pt
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IM
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what method of pain control is common in the post-op analgesia stage for the obese pt
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PCA
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when giving post-op analgesia for the obese pt the dose should be based on what ideal or total body wt
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IDEAL
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what kind of opioids are effective in the post-op analgesia tx for the obese
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NEURAXIAL
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weaning the obese pt post-op may be difficult d/t what
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*VQ mismatches
*decreased lung volumes *increased work of breathing |
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with obstructive sleep apnea and hypoventilation syndrome with the obese max decrease in PaO2 usually occurs when post-op
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2-3 days post-op
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