What does decreased compliance, decreased FRC, & impaired gas exchange do to the RR of an obese patient?
Causes rapid, shallow breathing
How does hyperinsulinemia cause HTN in an obese patient?
Increases Na+ retention
Which 2 drugs of the Fentany family has the largest Vd?
Fentanyl (6L)
Sufentanil (4L)
What is the duration of hydromorphone?
3-4 hours
What is the peak of hydromorphone?
15 mins
What is the onset of hydromorphone?
10-15 mins
What is the dose of hydromorphone?
0.5-2mg/dose
What is the duration of remifentail?
5-10 mins
What is the peak of remifentail?
1 min
What is the dose of Remifentail?
0.5 mcg/kg
Of the Fentanyl family, which causes the most bradycardia?
Sufentanil d/t potentcy
What is the duration of sufentanil?
30-45 mins
What is the peak of sufentanil?
3-5 mins
What is onset of sufentanil?
1 min
What is the dose of Sufentanil?
0.2-1 mcg/kg
What is the duration of Alfentanil?
20 mins
What is the peak of Alfentanil?
1-1.5 mins
What is the onset of Alfentanil?
90 seconds
What is the dose of Alfentanil?
5-10 mcg/kg
Of the Fentanyl family, which has the gretest cardioprotective effect?
Fentanyl
Of all the narcotics, which one has the greatest pulmonary uptake?
Fentanyl
What is the duration of Fentanyl?
30-60 mins
What is the peak of Fentanyl?
5-15 mins
What is the onset of Fentanyl?
1-2 mins
What is the dose of Fentayl?
1-5mcg/kg
Which receptors does Morphine work on?
Mu1 & Mu2
What is the duration of morphine?
4 hours
What is the peak of Morphine?
20 mins
What is the onset of Morphine?
5-10 mins
What is the dose of Morphine?
0.1mg/kg
T-burg & insufflation can drastically reduce chest wall excursion & reduce chest wall compliance. True or false
True
An obese patient has bigger lungs than a normal weighted patient? True or False
False
Why might regional anesthesia be reduced in an obese patient?
reduced up to 20% d/t systemic absorption &
reduced volume of epidural space
At what intra abdominal pressure can renal blood flow and UR be reduced?
>20 mm Hg
What is the most correct dose of Propofol for a 190kg patient with an IBS of 80kg who has no other medical problems?
A.
How is Remifentanil dosed in an obese patient?
IBW
How is Fentanyl & Sufentanil dosed for an obese patient?
Bolus - TBW
Maint - IBW
How is Roc/Vec dosed in an obese patient?
IBW
How is succs, Atracurium, & Cis dosed for an obese patient?
TBW - d/t metabolism
How is Midazolam dosed for an obese patient?
TBW
How is Propofol dosed in an obese patient?
IBW for induction
TBW for maint
How long does obese patients have an increased risk of hypoxemia post operatively?
First 24 hours & 2-5 days post op
Which of the following is false?
a. OHS is caused by the physical obstruction of air from entering the lungs.
b. OSA is defined as airflow obstruction >10 seconds
c. OSA has a central apnea component
d. All of the above are false
A & C
How does OHS differ from OSA?
conversion from peripheral causes of apea (peripheral) to central
In OHS, central events cause apnea without respiratory effort? True of False
True
What is a long-term consequence of OSA?
obesity hypoventilation syndrome
What are the pathologic effects of OSA?
daytime fatigue
hypoemia/acidosis
polycythemia
pulmonary HTN
Right heart disease
How is OSA treated?
CPAP or oral appliances
What is hypopnea?
decreased airflow from baseline that often results in desaturation
How is the severity of OSA defined?
number of apneic episodes per hour
>5/hr= OSA
How is OSA defined?
no airflow for >10 seconds
Is LMWH based upon TBW or IBW?
IBW
Why are obese patients at increased risk for thromboembolic Dz?
polycythemia
increased intra-abdominal pressure
immoblization
A patient presents with morbid obesity & a hiatal hernia. Which of the following is the BEST selection for this patient based on the info provided?
regular IV induction
d. use of an LMA, succs, & cricoid pressure
B.
Does obesity cause reduced gastric emptying & increased gastric volume?
No
Which of the following is true:
A. Obese Patient's have increased TLC
B. Obese patient's have decreased circulating blood volume
C. Obese Pt's have increased PVR
D. Obese patient's have decreased FRC
C & D
Do you see an increase or decrease in pulmonary vascular pressures?
increased
Does obesity cause an increase or decrease in blood volume?
Increased - to support excessive tissue
What type of lung disease does obesity mimic?
Restrictive Lung Disease
Is TV increased or decreased in obese patients?
decreased
Weight depedent decreases in TV causes what?
Increased RR
Do ou see an increased or decreased FRC/TLC in an obese person?
decreased
What are the 3 primary considerations of a difficult mask ventilation?
Increased BMI
Lack of teeth
Facial hair
What does a BMI >28 cause an increased risk for?
CVA
CAD
DM
What is the BMI range for overweight?
25-29.9kg
What is the minimum definition of obesity?
30kg/m2
What is pulmonary HTN in obese patients caused from?
