Propofol Infusion for Maintenance of Anesthesia in Morbidly Obese Patients Receiving Nitrous Oxide A Clinical and Pharmacokinetic Study

Servin, Frédérique; Farinotti, Robert; Haberer, J.-P.; Desmonts, Jean-Marie

doi:10.1097/00000542-199304000-00008

Cited by 269 publications

(165 citation statements)

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“…Our finding that morbid obesity increased the elimination clearance of propofol and the peripheral volume of distribution was consistent with previous studies in which the authors showed that total body clearance and the volume of distribution at steady state were positively correlated to body weight (Servin et al, 1993;Cortínez et al, 2010). An increase in the volume of distribution most likely results from the increased fat and lean masses of obese individuals (Casati and Putzu, 2005).…”

Section: Resultssupporting

confidence: 93%

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Morbid Obesity Alters Both Pharmacokinetics and Pharmacodynamics of Propofol: Dosing Recommendation for Anesthesia Induction

Dong

Peng

Liu

et al. 2016

Drug Metabolism and Disposition

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The prevalence of obesity has markedly increased worldwide. Obese patients pose significant challenges to anesthesiologists with regard to accurate dosing of anesthetics due to potentially altered pharmacokinetics (PK). Here we determined the PK and pharmacodynamics (PD) of propofol for anesthesia induction in morbidly obese (MO) subjects (body mass index >35 kg/m 2 ) at two dosing regimens: dosing based on total body weight and lean body weight (LBW), respectively. The propofol pharmacokinetic profile was well fitted with a twocompartment model. Both elimination clearance (223%-243% of controls, who had a body mass index <25 kg/m 2 ; P < 0.01) and peripheral compartment volume (156%-180% of controls; P < 0.01) were significantly increased in MO subjects, resulting in an equal or decreased propofol level in plasma (total body weight-based dosing).Furthermore, propofol PD (measured by the bispectral index) was adequately described by a PK/PD model that linked an effect compartment to the two-compartment PK model through a sigmoidal E max model. All PD parameters except EC 50 values (the half maximal effect concentration) were similar (P > 0.05) between MO subjects and controls. Morbid obesity led to a significant decrease (37.9%-38.6%; P < 0.01) in EC 50 values, which suggests increased brain sensitivity to propofol in the MO population. Moreover, dose reduction (i.e., dosing based on LBW) generated identical anesthetic effects in MO subjects compared with controls. In conclusion, morbid obesity significantly altered both PK and PD of propofol. LBW was a better weight-based dosing scalar for anesthesia induction with propofol in MO subjects.

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Section: Resultssupporting

confidence: 93%

“…Therefore, dose reduction seemed to be necessary for anesthesia induction in MO subjects. It was noteworthy that propofol maintenance infusion can be based on TBW in obese patients, as in lean subjects (Servin et al, 1993;Cortínez et al, 2010).…”

Section: Resultsmentioning

confidence: 99%

Morbid Obesity Alters Both Pharmacokinetics and Pharmacodynamics of Propofol: Dosing Recommendation for Anesthesia Induction

Dong

Peng

Liu

et al. 2016

Drug Metabolism and Disposition

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“…In the morbidly obese, the dosing of intravenous anaesthetics can be based on Ideal Body Weight [26], Corrected Body Weight [27] or Total Body Weight [28]. We used CBW for the calculation of the dosage of propofol [27].…”

Section: Discussionmentioning

confidence: 99%

“…We used CBW for the calculation of the dosage of propofol [27]. BIS may be used for the estimation of dosages of propofol in the morbidly obese [29].…”

Section: Discussionmentioning

confidence: 99%

Porównanie wartości BIS podczas całkowitego znieczulenia dożylnego z zastosowaniem propofolu i znieczulenia wziewnego sewofluranem u otyłych pacjentów

Gaszyński

Wieczorek²

2016

Anaesthesiol Intensive Ther

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Background: Intraoperative awareness is a rarely occurring phenomenon. Obesity is considered as one of the factors increasing the probability of intraoperative awareness due to problems with the dosing of anaesthetics. In a randomized prospective study we compared bispectral index (BIS) recordings during propofol-based total intravenous anaesthesia (TIVA) and sevoflurane-based inhalation anaesthesia in morbidly obese patients as a sign of possible intraoperative awareness. Methods: 120 morbidly obese patients were randomly allocated into two subgroups: TIVA or SEVO. Propofol TIVA was performed following the Servin formula, while sevoflurane was administered based on the age of the patients. The physician administering anaesthesia was blinded to the BIS recordings while the evaluation of the depth of anaesthesia was conducted based on the clinical symptoms of adequate anaesthesia. BIS recordings were evaluated for periods of BIS > 60. Blinded structured interviews were conducted 2 hours after anaesthesia was administrated. Results: The incidence of BIS > 60 occurred in 90% vs. 91.67% of patients while the mean duration of periods of BIS > 60 was 13.74 ± 21.74% vs. 14.21 ± 18.78% of the duration of anaesthesia in TIVA and SEVO groups, respectively (P > 0.05). There was no correlation between the BMI value and the duration of elevated BIS values observed during anaesthesia in both studied methods of anaesthesia, nor between the total time of anaesthesia and the duration of elevated BIS values above 60 in this study. No patient complained of intraoperative awareness when asked in the post-operative period, probably due to the administration of midasolam. Conclusions: Although the incidence of BIS > 60 are very common in obese patients, true awareness during anaesthesia infrequent in this group of patients despite the type of anaesthesia, whether intravenous or inhalation.

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“…Additionally, most studies examined the pharmacokinetics of bolus dosing followed by a continuous infusion as opposed to bolus dosing alone. A study by Servin et al 13 found no difference in initial volume of distribution when comparing obese patients to lean adults.…”

Section: Dosementioning

confidence: 94%

Retrospective Review of Propofol Dosing for Procedural Sedation in Pediatric Patients

Milius

Papademetrious

Heitlinger

2012

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES The purpose of this study was to determine the total propofol dose (mg/kg) for non-emergent pediatric procedural sedation and evaluate dosing differences with regard to a patient's sex, age, and body mass index. Adverse events were recorded and evaluated to determine whether certain patient groups were at a higher risk than others. METHODS This study was a retrospective observational pilot study including patients 0 to 18 years of age admitted between January 2008 and November 2009 for non-emergent gastrointestinal endoscopic procedures or radiologic imaging, who received propofol for procedural sedation. Data gathered included sex, age, height, weight, chronic medical conditions and medication use, concomitant anesthetic gas, preprocedure midazolam, procedure length, propofol dose in mg/kg, other medications administered during procedure, and adverse events that occurred. Comparisons between adverse event groups and categories of baseline characteristics were made using the Wilcoxon signed-rank, Kruskal-Wallis nonparametric and Pearson's chisquare tests, as appropriate. RESULTS A total of 101 patients met inclusion criteria and were included in the analysis. The mean dose of propofol required for female patients was 3.7 mg/kg versus 3.4 mg/kg for males (p=0.3). The mean dose of propofol for patients ≤9 years, 10 to 12 years, and >12 years was 3.2, 3.9, and 3.9 mg/kg, respectively (p=0.25). The mean dose of propofol for underweight, healthy weight, overweight, and obese patients was 4.2, 3.9, 3.6, and 2.6 mg/kg, respectively (p=0.38). Hypotension occurred in 42.6% of patients, and bradycardia occurred in 13.9% of patients. CONCLUSIONS There were no differences in dose requirements based on sex or age. The difference in dosing between different body weight categories was not statistically significant. The dose of propofol was higher in patients that experienced bradycardia and hypotension, but there was no statistical significance. Given the above, future studies with larger sample sizes should be conducted to establish if statistical significance exists.

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Propofol Infusion for Maintenance of Anesthesia in Morbidly Obese Patients Receiving Nitrous Oxide A Clinical and Pharmacokinetic Study

Cited by 269 publications

References 0 publications

Morbid Obesity Alters Both Pharmacokinetics and Pharmacodynamics of Propofol: Dosing Recommendation for Anesthesia Induction

Morbid Obesity Alters Both Pharmacokinetics and Pharmacodynamics of Propofol: Dosing Recommendation for Anesthesia Induction

Porównanie wartości BIS podczas całkowitego znieczulenia dożylnego z zastosowaniem propofolu i znieczulenia wziewnego sewofluranem u otyłych pacjentów

Retrospective Review of Propofol Dosing for Procedural Sedation in Pediatric Patients

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