Propofol Sedation for Intragastric Balloon Removal: Looking for the Optimal Body Weight Descriptor

Tsaousi, Georgia; Fyntanidou, Barbara; Stavrou, George; Papakostas, Pyrros; Kotzampassi, Katerina; Grosomanidis,

doi:10.1007/s11695-019-04075-0

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…Our observation of an increase in fentanyl and midazolam dose associated with increasing BMI is in keeping with two studies of other procedures using conscious sedation including bronchoscopy and firsttrimester surgical abortion (11,12). Similarly, an increase in propofol dose has been observed with increasing BMI in endoscopy under deep sedation (13), as well as OPUs for IVF under total intravenous anesthesia (9). This may be a result of increased volume of distribution of drugs due to higher percentage of body fat.…”

Section: Discussionsupporting

confidence: 87%

Impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup

et al. 2020

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Objective: To assess the impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup (OPU). Design: Retrospective cohort study. Setting: Hospital-based fertility clinic. Patient(s): All women undergoing OPU procedures during autologous in vitro fertilization (IVF) and oocyte banking cycles, grouped by patient body mass index (BMI: <25, 25-29.9, 30-34.9, 35-39.9, R40 kg/m 2). Intervention(s): Transvaginal OPU under conscious sedation. Main Outcome Measure(s): Sedation and procedure-related parameters and complications. Result(s): A total of 2,141 OPU procedures in 1,579 patients were analyzed, including 121 OPU procedures in 94 patients with BMI R40 kg/m 2. There was a statistically significant increase in total fentanyl and midazolam doses and procedure duration as BMI increased. Compared with patients with BMI <25 kg/m 2 , those with BMI R40 kg/m 2 were more likely to require additional sedation during the procedure (adjusted odds ratio [aOR] 1.99; 95% confidence interval [CI], 1.14-3.49). The rate of difficult access was 28.9% for procedures with BMI R40 kg/m 2 compared with 5.2% with BMI <25 kg/m 2 (aOR 7.57; 95% CI, 4.66-12.29). The OPU was incomplete due to inaccessible follicles through a transvaginal approach in 18.2% of procedures with BMI R40 kg/m 2 compared with 1.3% with BMI <25 kg/m 2 (aOR 16.94; 95% CI, 8.24-34.84). The rates of sedation and procedure-related complications were low, and none occurred in patients with BMI R40 kg/m 2. Conclusion(s): There was no increased risk of complications for women with class III obesity undergoing OPU with conscious sedation. However, the operator was more likely to encounter difficult access and to incompletely aspirate follicles through a transvaginal approach. (Fertil Steril Rep Ò 2020;1:270-6. Ó2020 by American Society for Reproductive Medicine.

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Section: Discussionsupporting

confidence: 87%

Impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup

et al. 2020

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“…2 Studies have shown that the heavier the bodyweight, the higher the prevalence of hypoxemia. 3 In addition, the high prevalence of hypoxemia may be associated with mortality, myocardial ischemia, brain injury, and the risk of mechanical ventilation. [4][5][6][7] Extensive researches have been carried out on propofol in combination with other drugs to lower the risk of hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

Li¹,

Lv²,

Jiang³

et al. 2020

DDDT

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Propofol for procedural sedation and analgesia (PSA) for colonoscopy can result in a high prevalence of severe respiratory depression. Studies have shown that intravenous (IV) infusion of lidocaine can reduce propofol requirements significantly and increase the ventilatory response to carbon dioxide in humans. We tested the hypothesis that IV lidocaine could improve propofol-induced respiratory depression in obese patients during colonoscopy. Methods: Ninety obese patients scheduled for painless colonoscopy were randomized to receive lidocaine (1.5 mg/kg, then 2 mg/kg/h, IV) or the same volume of 0.9% saline. Intraoperative sedation was provided by propofol. The primary outcome was the number of oxygen-desaturation episodes. Secondary outcomes were: the number of apnea episodes; total propofol consumption; time to the first hypoxia episode; time to consciousness loss; intraoperative hemodynamic parameters; awakening time; adverse events; duration of postanesthesia care unit (PACU) stay; satisfaction of endoscopists and patients. Results: Demographic characteristics between the two groups were comparable. The number of oxygen-desaturation episodes in group L (1.49±1.12) decreased by 0.622 (P=0.018) compared with that in group N (2.11±1.32), and the number of apnea episodes in group L decreased by 0.533 (P<0.001). Kaplan-Meier curves showed that the median time to the first hypoxia episode was longer in group L (86.78 s) than that in group N (63.83 s) (Log rank P=0.0008). The total propofol consumption, awakening time, and duration of PACU stay were reduced in group L. There was no significant difference in the prevalence of adverse events (P>0.05 for all). Satisfaction scores for endoscopists and patients in group L were higher than that in group N (P<0.001). Conclusion: Intravenous infusion of lidocaine could significantly reduce the number of oxygen-desaturation and apnea episodes in obese patients during painless colonoscopy. This method is worthy of clinical promotion. Clinical Trials Registration: ChiCTR2000028937.

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“…In addition to the studies that reported LBW as a covariate on CL, four studies (one on folic acid and three on propofol) recommended adjusting the dose for obese patients based on LBW, as dosing according to LBW provided superior systemic exposure compared to other size-based dosing strategies [58][59][60]127]. However, for propofol, how to adjust the dose in obese individuals remains controversial, as two other studies found a non-linear relation between CL and TBW [40,48], while a sixth study suggested that no dose adjustment was needed which may be due to the weight range in this study was small [61].…”

Section: Literature Results On Lbw As Clearance Scalar For the Obesementioning

confidence: 99%

Drug pharmacokinetics in the obese population: challenging common assumptions on predictors of obesity-related parameter changes

Zhang

Krekels

Smit

et al. 2022

Expert Opinion on Drug Metabolism & Toxicology

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Introduction:Obesity is associated with many physiological changes. We review available evidence regarding five commonly accepted assumptions to a priori predict the impact of obesity on drug pharmacokinetics (PK). Areas covered: The investigated assumptions are: 1) lean body weight is the preferred descriptor of clearance and dose adjustments; 2) volume of distribution increases for lipophilic, but not for hydrophilic drugs; 3) CYP-3A4 activity is suppressed and UGT activity is increased, implying decreased and increased dose requirements for substrates of these enzyme systems, respectively; 4) glomerular filtration rate is enhanced, necessitating higher doses for drugs cleared through glomerular filtration; 5) drug dosing information from obese adults can be extrapolated to obese adolescents. Expert opinion: Available literature contradicts, or at least limits the generalizability, of all five assumptions. Clinical studies should focus on quantifying the impact of duration and severity of obesity on drug PK in adults and adolescents, and also include oral bioavailability and pharmacodynamics in these studies. Physiologically based PK approaches can be used to predict PK changes for individual drugs but can also be used to define in general terms based on patient characteristics and drug properties, when certain assumptions can or cannot be expected to be systematically accurate.

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Propofol Sedation for Intragastric Balloon Removal: Looking for the Optimal Body Weight Descriptor

Cited by 7 publications

References 38 publications

Impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup

Impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

Drug pharmacokinetics in the obese population: challenging common assumptions on predictors of obesity-related parameter changes

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