Obesity
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Obesity

Created by
@WorkableCreativity2568

Questions and Answers

What is a key recommendation regarding screening for OSA preoperatively?

Screen 100% of patients

What is a long-term complication associated with OSA?

Hypoxemia

Why is screening everyone for OSA important?

It impacts clinical decision making and risk stratification for the patient

What is a potential consequence of Obesity Hypoventilation Syndrome (OHS)?

<p>Polycythemia</p> Signup and view all the answers

Why might a room air ABG be necessary in some cases?

<p>To help in decision-making regarding OSA treatment compliance</p> Signup and view all the answers

What is the most common qualifier used to define obesity?

<p>BMI</p> Signup and view all the answers

What term is replacing 'morbid obesity'?

<p>Clinically severe obesity</p> Signup and view all the answers

Which condition is associated with a higher metabolic syndrome rate?

<p>Central obesity</p> Signup and view all the answers

What happens to adipocytes after they reach a BMI of 40 kg/m2?

<p>They start multiplying/dividing</p> Signup and view all the answers

What condition is characterized by cessation of breathing for longer than 10 seconds during sleep?

<p>Obstructive sleep apnea</p> Signup and view all the answers

Which factor leads to increased anesthesia risk in obese patients?

<p>Engorged adipocytes</p> Signup and view all the answers

BMI is a direct measure of adipose tissue.

<p>False</p> Signup and view all the answers

Engorged adipocytes increase cytokine secretion and decrease secretion of adiponectin.

<p>True</p> Signup and view all the answers

Chronic hypertension in obesity can be indirectly attributed to hyperinsulinemia.

<p>True</p> Signup and view all the answers

What is STOP BANG

<p>screening for OSA, severity of OSA. Snoring. Tiredness. Observed apnea. Pressure (HTN). BMI. Age. Neck circumference. Gender</p> Signup and view all the answers

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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