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Questions and Answers
What is a key recommendation regarding screening for OSA preoperatively?
What is a long-term complication associated with OSA?
Why is screening everyone for OSA important?
What is a potential consequence of Obesity Hypoventilation Syndrome (OHS)?
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Why might a room air ABG be necessary in some cases?
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What is the most common qualifier used to define obesity?
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What term is replacing 'morbid obesity'?
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Which condition is associated with a higher metabolic syndrome rate?
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What happens to adipocytes after they reach a BMI of 40 kg/m2?
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What condition is characterized by cessation of breathing for longer than 10 seconds during sleep?
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Which factor leads to increased anesthesia risk in obese patients?
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BMI is a direct measure of adipose tissue.
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Engorged adipocytes increase cytokine secretion and decrease secretion of adiponectin.
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Chronic hypertension in obesity can be indirectly attributed to hyperinsulinemia.
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What is STOP BANG
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Study Notes
Definition and Epidemiology of Obesity
- Obesity is defined as an abnormally high amount of adipose tissue compared to lean muscle mass (>20% over ideal body weight IBW)
- BMI is the most common qualifier for obesity, but it's not a direct measure of adipose tissue
- Morbid obesity is being replaced with “clinically severe obesity”
Impact of Obesity
- Obese patients' annual healthcare cost is 42% higher than non-obese
- Obesity is linked to a decreased life expectancy, with a premature death rate that is double that of non-obese individuals
- The risk of CV-related death is 5 times higher in obese individuals
- Obesity is associated with significant anesthesia risks
Pathophysiology of Obesity
- Most metabolic activity occurs in lean muscle
- Adipocytes increase in size, and then start dividing when BMI reaches 40 kg/m2
- Central obesity is associated with a higher metabolic syndrome rate
- Adipose deposits lead to decreased insulin secretion, and engorged adipocytes are resistant to insulin
Preoperative Concerns
- Hypertension
- Coronary disease
- Respiratory concerns
- Obesity Hypoventilation Syndrome (OHS)
- GI concerns
- MS Hypertension in Obesity
- Cardiac Changes in Obesity leading to Heart Failure
- OSA (Obstructive Sleep Apnea)
- Cessation of breathing longer than 10 sec during sleep
- Hypopnea is a reduction in size or number of breaths compared with normal ventilation
OSA and OHS
- OSA leads to hypoxemia, daytime somnolence, hypercarbia, HTN, pulmonary HTN, and RV failure
- 100% of patients should be screened for OSA preoperatively using the STOP-BANG questionnaire
- Long-term complications of OSA include nocturnal episodes of central apnea and progressive desensitization of the respiratory center to hypercarbia
- OHS leads to Pickwickian Syndrome, characterized by daytime hypersomnolence, hypoxemia, hypercarbia, polycythemia, respiratory acidosis, pulmonary hypertension, and RV failure
Preoperative Evaluation
- Focus on CV and respiratory systems
- Sedentary lifestyle may limit determination of METS
- May need more workup beyond EKG and ROS
- Screen everyone for OSA, as it impacts clinical decision making and risk stratification for the patient
- Specifically look for signs of LV failure, pulmonary HTN, and compliance with OSA treatment
- Sometimes need room air ABG to help in decision-making
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