Podcast
Questions and Answers
What is a key recommendation regarding screening for OSA preoperatively?
What is a key recommendation regarding screening for OSA preoperatively?
- Screen patients based on their METS level
- Screen only patients with daytime hypersomnolence
- Only screen patients with known obesity
- Screen 100% of patients (correct)
What is a long-term complication associated with OSA?
What is a long-term complication associated with OSA?
- Hypoglycemia
- Dehydration
- Hyperkalemia
- Hypoxemia (correct)
Why is screening everyone for OSA important?
Why is screening everyone for OSA important?
- It determines the patient's renal function
- It impacts clinical decision making and risk stratification for the patient (correct)
- It helps in determining the patient's height and weight ratio
- It assesses the patient's blood glucose levels
What is a potential consequence of Obesity Hypoventilation Syndrome (OHS)?
What is a potential consequence of Obesity Hypoventilation Syndrome (OHS)?
Why might a room air ABG be necessary in some cases?
Why might a room air ABG be necessary in some cases?
What is the most common qualifier used to define obesity?
What is the most common qualifier used to define obesity?
What term is replacing 'morbid obesity'?
What term is replacing 'morbid obesity'?
Which condition is associated with a higher metabolic syndrome rate?
Which condition is associated with a higher metabolic syndrome rate?
What happens to adipocytes after they reach a BMI of 40 kg/m2?
What happens to adipocytes after they reach a BMI of 40 kg/m2?
What condition is characterized by cessation of breathing for longer than 10 seconds during sleep?
What condition is characterized by cessation of breathing for longer than 10 seconds during sleep?
Which factor leads to increased anesthesia risk in obese patients?
Which factor leads to increased anesthesia risk in obese patients?
BMI is a direct measure of adipose tissue.
BMI is a direct measure of adipose tissue.
Engorged adipocytes increase cytokine secretion and decrease secretion of adiponectin.
Engorged adipocytes increase cytokine secretion and decrease secretion of adiponectin.
Chronic hypertension in obesity can be indirectly attributed to hyperinsulinemia.
Chronic hypertension in obesity can be indirectly attributed to hyperinsulinemia.
What is STOP BANG
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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