Performance of Propofol Target-Controlled Infusion Models in the Obese

Abstract

The Eleveld allometric PK model proved to be superior to all other tested models using TBW. All models, however, showed a trend to underestimate propofol concentrations. The use of adjusted body weight instead of TBW with the traditional Schnider and Marsh models markedly improved their performance achieving the lowest predictive errors of all tested models. Our results suggest no relevant effect of obesity on both the time profile of BIS response and the propofol concentration-BIS relationship.

Swallowing Impairment During Propofol Target-Controlled Infusion

“…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).…”

Obesity and Chronic Pain

“…Changes in drug absorption after bariatric surgery as well as evolving hormonal alterations must be considered. 207,208 An integrated approach, including collaborative multidisciplinary care that modifies surgical methods and uses additional pain management tools, can decrease the requirement for opioids and encourage rehabilitation. 181,209,210 Concerning reports indicate that some patients (13%) suffer from worsened depression after bariatric surgery.…”

Model-based drug administration

“…Aside this, better models in children might be required anyway as some of the existing paediatric models showed a poor performance [18,19]. Although some newer models have been published for specific patient groups such as for the obese patient [20,21], a general purpose PK/ PD model for propofol covering both children, adults and obesity might be a significant step forward in an attempt to make propofol model selection easier for the clinician. Using nearly all previously published data offered by the original authors (10 927 blood samples from 660 individuals), Eleveld and colleagues [22 && ] were able to determine a pharmacokinetic model with robust predictive performance for a wide range of patients groups and clinical conditions.…”