Anesthetizing the obese child

Abstract

The prevalence of childhood obesity is increasing. The focus of this review is the special anesthetic considerations regarding the perioperative management of obese children. With obesity the risk of comorbidity such as asthma, obstructive sleep apnea, hypertension, and diabetes increases. The obese child has an increased risk of perioperative complications especially related to airway management and ventilation. There is a significantly increased risk of difficult mask ventilation and perioperative desaturation. Furthermore, obesity has an impact on the pharmacokinetics of most anesthetic drugs. This has important implications on how to estimate the optimal drug dose. This article offers a review of the literature on definition, prevalence and the pathophysiology of childhood obesity and provides suggestions on preanesthetic evaluation, airway management and dosage of the anesthetic drugs in these patients. The authors highlight the need of supplemental studies on various areas of the subject.

Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea

“…It is well known that obese subjects have altered pharmacokinetics, larger volume of distribution of drugs, variable lipid solubility of anesthetic inhalational medications, increased risk of airway complications, higher oxygen consumption, and decreased pulmonary reserve. 21 These factors place obese children at a much higher postoperative risk. There is limited literature on anesthetizing the obese child and this is an area of growing interest given increased prevalence of childhood obesity.…”

“…20 Obesity can alter the volume of distribution and pharmacokinetics of anesthetic drugs that can further compromise airway and respiratory effects of medications. 21 Finally, local postoperative tissue edema may compromise the upper airway, especially if other soft-tissue debulking surgery is performed in addition to AT.…”

An aid to drug dosing safety in obese children: development of a new nomogram and comparison with existing methods for estimation of ideal body weight and lean body mass

“…Obese children may also have related co-morbidities such as obstructive sleep apnoea or fatty infiltration of the liver [3]. Dose adjustment according to dosing scalars such as ideal body weight (IBW), lean body mass (LBM) and TBW depends upon the specific drug [1,2,4,5]. Examples include the use of IBW for intubation doses of non-depolarising neuromuscular blocking drugs, TBW for the dose of suxamethonium in rapid sequence induction and LBM for induction doses of propofol.…”

“…where ideal BMI (BMI 50 ) is the BMI value on the 50th centile of a UK BMI chart for the child's age and sex [4][5][6][7][8].…”

Do Obese Children Require Inpatient Monitoring After Adenotonsillectomy?

“…As outlined by the authors, several factors may play a role including intrinsic effect of obesity on ventilator control, decreased pulmonary reserve, and alteration of volume of distribution and pharmacokinetics of anesthetics and narcotic medications. 11,12 Interestingly, the authors did not find the correlation between postoperative narcotics doses and obstructive and central respiratory events. However, the number of subjects was small and may not be adequate to evaluate this issue.…”