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Obesity Classification and Risks

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Questions and Answers

Obesity is classified using the body mass index (BMI). Which of the following BMIs is considered "morbid obesity"?

36-40

18.5-25

41+ (correct)

26-30

31-35

Which of the following are coexisting diseases associated with obesity? (Select all that apply)

Obstructive sleep apnea (correct)

Type 2 diabetes mellitus (correct)

Hypertension (correct)

Degenerative joint disease (osteoarthritis) (correct)

Coronary artery disease (correct)

Obese patients always have hypercapnia.

False

What is the most important respiratory consideration in obese patients?

Hypoxemia Signup and view all the answers

The risk of postoperative hypoxia is increased in patients with preoperative hypoxia following surgery involving the thorax or the upper abdomen.

True Signup and view all the answers

It is always safe to extubate an obese patient when the effects of neuromuscular blocking agents (NMBAs) are completely reversed.

False Signup and view all the answers

Obese patients often require higher doses of local anesthetics for epidural or spinal anesthesia compared to non-obese patients.

False Signup and view all the answers

What are the advantages of regional anesthesia in obese patients? (Select all that apply)

Decreased cardiopulmonary depression Signup and view all the answers

What are the potential complications associated with Obesity Hypoventilation Syndrome (OHS)?

Hypercapnia, Cyanosis-induced polycythemia, Right-sided heart failure, Somnolence Signup and view all the answers

A 45° modified sitting position can improve ventilation and oxygenation in postoperative obese patients.

True Signup and view all the answers

Preoperative treatment with H2 antagonists and metoclopramide is generally recommended for obese patients due to the risk of aspiration pneumonia.

True Signup and view all the answers

Regional nerve blocks are never recommended for obese patients because of the potential for complications.

False Signup and view all the answers

Study Notes

Obesity Classification

Obesity is categorized by BMI (body mass index)
Overweight: BMI of 24 kg/m² or higher
Obesity class 1 & 2: BMI of 30 kg/m² or higher
Extreme obesity (morbid obesity): BMI over 40 kg/m²

BMI Calculation

BMI = weight (kg) / (height [m])²

Obesity Definition

BMI of 18.5-25: Normal range
BMI of 26-30: Overweight
BMI of 31-35: Class I obesity
BMI of 36-40: Class II obesity
BMI of 41+: Morbid obesity

Increased mortality and morbidity
Increased abdominal fat increases health risk
Men with waist ≥ 40 inches and women with waist ≥ 35 inches are at a higher risk

Comorbidities in Obesity

Type 2 diabetes mellitus
Hypertension
Coronary artery disease

Respiratory Considerations in Obese Patients

Difficult airway possibility
Asthma risk
Breathing/ obstructive sleep apnea (OSA)
Restrictive lung disease
Chronic hypoxia (with or without polycythemia)
Pulmonary hypertension
Increased work of breathing due to larger chest wall mass, reduced compliance, and reduced diaphragmatic excursion
Restrictive lung disease develops, areas of lung underventilated.
Compensating vasoconstriction leads to pulmonary hypertension, right-sided heart failure
Increased oxygen consumption and carbon dioxide production
Elevated metabolic rate

Anesthetic Considerations and Complications

Increased oxygen demand, CO2 production, and alveolar ventilation
Excessive adipose tissue decreases chest wall compliance
Obese patients are often hypoxemic with fewer hypercapnic, leading to (OSA)
Obesity hypoventilation syndrome (OSA)
Hypercapnia
Cyanosis-induced polycythemia
Right-sided heart failure
Somnolence
Hypoxia
Hypertension
Arrhythmias
Myocardial infarction
Pulmonary edema
Stroke
Death
Difficult mask ventilation and intubation possible
Postoperative continuous positive airway pressure (CPAP) may be required
Increased cardiac output
Increased blood volume
Circulating blood volume increases
Pulmonary hypertension and cor pulmonale
Gastroesophageal reflux disease (GERD)
Delayed gastric emptying
Hyperacidic gastric fluid
Fatty liver infiltration
Blood pressure checks with appropriately sized cuffs
Potential for difficulty with regional anesthesia, obscured landmarks, and adipose tissue layers. Temporomandibular and atlantooccipital joint mobility issues, narrow upper airway, and shortened mandible-sternal fat pad distance.
Respiratory failure is a major postoperative issue in obese patients, especially post-thoracic/abdominal surgery.
Delayed extubation till neuromuscular blockers (NMBs) effects reversed.
Supplemental oxygen and adequate airway/tidal volume are critical post-op.
45° modified sitting position improves ventilation.
Postoperative hypoxia risk; supplemental oxygen or CPAP may be needed
Common post-op complications include:
Wound infections
Deep vein thrombosis (DVT)
Pulmonary embolism

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Description

This quiz covers the classification of obesity based on BMI, including normal, overweight, and various obesity classes. Additionally, it explores the health risks associated with obesity, including comorbidities like type 2 diabetes and hypertension. Test your knowledge on the key concepts surrounding obesity and its implications on health.