No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients

Colla, Luca La; Albertin, A.; Colla, G. La; Ceriani, Valerio; Lodi, Tiziana; Porta, Andrea; Aldegheri, Giorgio; Mangano, Alberto; Khairallah, Ilias; Fermo, Isabella

doi:10.1097/eja.0b013e328326f7d0

Cited by 49 publications

(26 citation statements)

References 21 publications

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“…17 In setting our TCI infusion system, we entered patients' total body weight. Although some studies support the use of total body-weight-based schemes during propofol TCI, even in obese patients, 25 recent evidence suggest that adequately adjusted body weight improves the performance of propofol TCI models. 26 The possible underestimation of propofol concentration in higher BMI patients could have contributed to the effect of increasing BMI on swallowing impairment in our study, although we did not observe any severely obese patient in our series, and only 5 patients exhibited moderate obesity with a BMI >30 (maximum, 33.8).…”

Section: Discussionmentioning

confidence: 99%

Swallowing Impairment During Propofol Target-Controlled Infusion

Gemma

Pasin

Oriani

et al. 2016

Anesthesia &Amp; Analgesia

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Section: Discussionmentioning

confidence: 99%

Swallowing Impairment During Propofol Target-Controlled Infusion

Gemma

Pasin

Oriani

et al. 2016

Anesthesia &Amp; Analgesia

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“…For target-controlled systems, it is recommended that infusion is also based on the morbidly obese TBW without adjustment and that an EEG-based device should be used to monitor depth of anaesthesia during the predicted plasma propofol concentrations. 37 Succinylcholine A dose of 1 mg kg À1 TBW of succinylcholine is needed to ensure good or excellent intubation conditions. Lower doses are associated with poorer intubation conditions but without sufficient recovery of spontaneous ventilation, should ventilation or intubation fail.…”

Section: Propofolmentioning

confidence: 99%

Airway management and morbid obesity

Kristensen

2010

European Journal of Anaesthesiology

110

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Morbidly obese patients present with excess fatty tissue externally on the breast, neck, thoracic wall and abdomen and internally in the mouth, pharynx and abdomen. This excess tissue tends to make access (intubation, tracheostomy) to and patency (during sedation or mask ventilation) of the upper airway and the function of the lungs (decreased residual capacity and aggravated ventilation perfusion mismatch) worse than in lean patients. Proper planning and preparation of airway management is essential, including elevation of the patient's upper body, head and neck. Preoxygenation is mandatory in morbidly obese patients and should be followed by actions to counteract atelectasis formation. The decision as to weather to use a rapid sequence induction, an awake intubation or a standard induction with hypnotics should depend on the thorough airway examination and comorbidity and should not be based solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more efficient in the morbidly obese patients than in lean patients and serves as a rescue device for both failed ventilation and failed intubation. In the 24 h following anaesthesia, morbidly obese patients experience frequent oxygen desaturation periods that can be counteracted by continuous positive airway pressure, noninvasive ventilation and physiotherapy.

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“…Manual infusion schemes tend to be based solely on body weight with limited allowance for the morbidly obese child or for developmental changes in important parameters such as drug clearance. Recent evidence suggests that propofol infusion rates in the obese patient are better determined by EEG-feedback rather than total body weight [13].…”

Section: Manual Infusion Schemesmentioning

confidence: 99%

Total Intravenous Anesthesia (TIVA) and Target Controlled Infusions (TCI) in Children

Morton

2012

Curr Anesthesiol Rep

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Total intravenous anesthesia is increasingly used in children and in some situations is mandatory, for example in the child with malignant hyperthermia susceptibility. Propofol is most often used, either alone or concurrently with an opioid infusion. Pediatric dosing regimens have been calculated in small populations of healthy children and act as a guide for administration. Manual infusion schemes can be used quite effectively using conventional syringe drivers. Specifically programmed syringe drivers enable more careful titration to an estimated target concentration in blood or at the effect site using algorithms based upon pediatric pharmacokinetic data (target controlled infusion). In the future, more precise dosing and titration will be aided by near-real-time propofol analysis in blood or exhaled gases and further refinement of depth of anesthesia monitoring in children.

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No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients

Abstract: Weight adjustment causes a clinically unacceptable performance bias, which is not corrected when TBW is used as an input to the 'Marsh' model. It is, therefore, advisable to administer propofol to morbidly obese patients by titration to targeted processed-EEG values.

Cited by 49 publications

References 21 publications

Swallowing Impairment During Propofol Target-Controlled Infusion

Swallowing Impairment During Propofol Target-Controlled Infusion

Airway management and morbid obesity

Total Intravenous Anesthesia (TIVA) and Target Controlled Infusions (TCI) in Children

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