15 Questions
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)?
Polycythemia
Why might a room air ABG be necessary in some cases?
To help in decision-making regarding OSA treatment compliance
What is the most common qualifier used to define obesity?
BMI
What term is replacing 'morbid obesity'?
Clinically severe obesity
Which condition is associated with a higher metabolic syndrome rate?
Central obesity
What happens to adipocytes after they reach a BMI of 40 kg/m2?
They start multiplying/dividing
What condition is characterized by cessation of breathing for longer than 10 seconds during sleep?
Obstructive sleep apnea
Which factor leads to increased anesthesia risk in obese patients?
Engorged adipocytes
BMI is a direct measure of adipose tissue.
False
Engorged adipocytes increase cytokine secretion and decrease secretion of adiponectin.
True
Chronic hypertension in obesity can be indirectly attributed to hyperinsulinemia.
True
What is STOP BANG
screening for OSA, severity of OSA. Snoring. Tiredness. Observed apnea. Pressure (HTN). BMI. Age. Neck circumference. Gender
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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