Obesity.pptx

Obesity Advanced Health Assessment Definition & Epidemiology Abnormally high amount of adipose tissue compared with lean muscle mass (>20% over ideal body weight IBW) BMI most common qualifier but NOT a direct measure of adipose tissue Faults – think body builders Morbid obesity is being replaced wi...

Obesity Advanced Health Assessment Definition & Epidemiology Abnormally high amount of adipose tissue compared with lean muscle mass (>20% over ideal body weight IBW) BMI most common qualifier but NOT a direct measure of adipose tissue Faults – think body builders Morbid obesity is being replaced with “clinically severe obesity” As obesity rises, so do comorbid conditions Surgical Impact Obese patients' annual healthcare cost is 42% higher than non-obese Clear link to decreased life expectancy Premature death rate is double non-obese Risk of CV-related death is 5 times higher Significant anesthesia risk associated with obesity Brief Patho Most metabolic activity occurs in lean muscle Adipocytes increase in size, to a point, then start dividing BMI 40 kg/m2 = large adipocytes Over 40, division starts Central obesity associated with higher metabolic syndrome rate Adipose deposits lead to decreased insulin secretion, angorged adipocytes are resistant to insulin Engorged adipocytes  cytokine secretion increases and adiponectine decreases (powerful insulin synsitizer) Preop Concerns Hypertension Coronary disease Respiratory concerns Obesity Hypoventilation Syndrome (OHS) GI MS Hypertension in Obesity Cardiac Changes in Obesity  Heart Failure OSA Cessation of breathing longer than 10 sec during sleep Hypopnea is reduction in size or number of breaths compared with normal ventilation Leads to hypoxemia, daytime somnolence, hypercarbia, HTN, pulmonary HTN, and RV failure 100% of patients should be screened for OSA preoperatively STOP-BANG Obesity Hypoventilation Syndrome Long-term complications of OSA Nocturnal episodes of central apnea Progressive desensitization of respiratory center to hypercarbia OHS leads to Pickwickian Syndrome Obesity Daytime hypersomnolence Hypoxemia Hypercarbia Polycythemia Respiratory acidosis Pulmonary hypertension RV failure Specific Considerations Focus on CV and respiratory systems Sedentary lifestyle might limit determination of METS May need more workup (beyond EKG and ROS) Screen everyone for OSA  impacts clinical decision making and risk stratification for your patient Specifically looking for signs of LV failure, pulmonary HTN, and compliance with OSA treatment Sometimes need room air ABG to help in decisionmaking