How should anesthetics be dosed in obese patients?

How should anesthetics be dosed in obese patients?

In general, lean body weight is the most appropriate dose for most anesthetic drugs, with the exception of NDMB, where ideal body weight may be more appropriate. Succinylcholine should be dosed to total body weight.

Do obese patients need more anesthesia?

One of the biggest concerns is that being overweight makes you more likely to have a condition called sleep apnea, which causes you to temporarily stop breathing while you sleep. This can make anesthesia riskier, especially general anesthesia, which causes you to lose consciousness.

Can obese people get anesthesia?

“We have found compelling evidence that obese patients are very safe undergoing an anesthetic, but our preliminary data suggest that they are at a greater risk for airway, respiratory, and other complications,” says Blum in the news release.

How does obesity affect sedation?

Higher BMI is also likely associated with higher adipose mass, a reduction in total body water, higher glomerular filtration rate (GFR) and normal hepatic clearance, which may lead to higher sedative dose requirement and thus increased sedation risks [21].

Which dosing scalar is most appropriate for dosing sedation medications for overweight patients?

Summary. For dosing etomidate, ABW is suggested for weight-based dosing in obese patients with a BMI < 40 kg/m2. Dosing using either adjusted or ABW is suggested in patients with more severe forms of obesity (e.g., BMI ≥ 40 kg/m2).

Should dosing of rocuronium in obese patients be based on ideal or corrected body weight?

Background: Pharmacokinetic studies in obese patients suggest that dosing of rocuronium should be based on ideal body weight (IBW). This may, however, result in a prolonged onset time or compromised conditions for tracheal intubation.

Why can’t obese people have surgery?

In addition, obesity has a great impact on surgical diseases, and elective surgeries in comparison to general population. There is higher risk for wound infection, longer operative time, poorer outcome, and others. The higher the BMI (body mass index), the higher the risk for these complications.

What are the surgical risk factors and potential complications for obese patients?

Obesity Raises Surgery Risks

• Five times higher rate of heart attack.
• Four times higher rate of peripheral nerve injury.
• 1.7 times higher rate of wound infection.
• 1.5 times higher rate of urinary tract infection.

What is the weight limit for anesthesia?

Most operating tables are designed for patients of up to 120–140 kg in weight. For those who weigh more than this limit, specially designed tables may be needed. Position should be maintained to prevent nerve compressions and pressure sores.

What drugs are dosed by ideal body weight?

Carvedilol, apixaban, ribavirin and prasugrel. Some drugs have a licensed dichotomised dose based on total body weight. The maximum daily dose of carvedilol is 50 mg in patients weighing less than 85 kg and 100 mg for patients weighing 85 kg or more.

How do you calculate lean body weight with anesthesia?

The one most often used to calculate adult IBW is Broca’s index:

1. IBW (kg) = height(cm) – x.
2. Obese patients typically have 20-30% more lean body mass. So the IBW for an obese patient would look like this: Obese IBW = IBW x 1.3.
3. IBW = 2 x Age(years) + 9.
4. IBW = 3 x Age(years)
5. References. Butterworth.

Is propofol dosed on ideal body weight?

Although some studies support the use of ABW-based dosing for propofol, the relationship between weight and pharmacokinetic variables such as clearance is nonlinear. Dosing using ABW may result in supratherapeutic concentrations. Thus, weight-based dosing using either IBW or adjusted body weight is preferred.

Can anesthesiologists treat obese patients?

Anesthesiologists are increasingly being faced with treating obese patients. Physiologic and anthropometric associated with obesity—most notably increases in cardiac output, changes in tissue perfusion and increases in total body weight (TBW), lean body weight (LBW), and fat mass affect the pharmacokinetics (PK) of anesthetic agents.

How does obesity affect the distribution of general anesthetic agents?

Obesity is associated with an increase in cardiac output and in total blood volume, which may alter drug distribution, peak concentration and clearance. [ 7, 9] In addition, increases in fat- and lean-body mass and changes in tissue perfusion may affect the apparent volume of distribution of many anesthetic agents.

How does body weight affect pharmacokinetics?

Physiologic and anthropometric associated with obesity—most notably increases in cardiac output, changes in tissue perfusion and increases in total body weight (TBW), lean body weight (LBW), and fat mass affect the pharmacokinetics (PK) of anesthetic agents.

How does obesity affect the pathophysiology of alfentanil toxicity?

Like fentanyl, the increased cardiac output in obese subjects lowers the plasma concentration of alfentanil during the early distribution phase.[43] Obese individuals should have a theoretically increased volume of distribution and longer terminal elimination half-time compared to normal weight subjects.