Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-26T22:19:00.866Z Has data issue: false hasContentIssue false

Chapter 16 - Big Can Be Beautiful!

How to Use TIVA in the Obese

Published online by Cambridge University Press:  18 November 2019

By
Luis Ignacio Cortínez  and
Brian Anderson
Edited by
Michael G. Irwin ,
Gordon T. C. Wong  and
Shuk Wan Lam
Michael G. Irwin
Affiliation:
The University of Hong Kong
Gordon T. C. Wong
Affiliation:
The University of Hong Kong
Shuk Wan Lam
Affiliation:
The University of Hong Kong
Get access

Summary

Obesity is a chronic disease characterised by the presence of excessive body fat that increases the risk of health problems. Traditionally, the administration of TIVA and TCI in the obese has been done using dose schemes extrapolated from non-obese patients. The use of such schemes has proven inadequate in the obese and they are commonly associated with overdose.[1,2] Dosing strategies of IV anaesthetics in heavy weight patients requires approaches that differ from those used in lean patients due to physiological and pharmacological changes associated with obesity.[3] This chapter is intended to be a practical guide for anaesthetists who wish to undertake TIVA and TCI in obese patients.

Type
Chapter
Information
Taking on TIVA
Debunking Myths and Dispelling Misunderstandings
 , pp. 132 - 138
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Coetzee, J.F.. Allometric or lean body mass scaling of propofol pharmacokinetics: towards simplifying parameter sets for target-controlled infusions. Clin Pharmacokinet 2012; 51: 137–45.CrossRefGoogle ScholarPubMed
Eleveld, D.J., Proost, J.H., Absalom, A.R., Struys, M.M.. Obesity and allometric scaling of pharmacokinetics. Clin Pharmacokinet 2011; 50: 751–3.CrossRefGoogle ScholarPubMed
Cheymol, G.. Effects of obesity on pharmacokinetics implications for drug therapy. Clin Pharmacokinet 2000; 39: 215–31.Google Scholar
Must, A., Anderson, S.E.. Body mass index in children and adolescents: considerations for population-based applications. Int J Obes 2006; 30: 590–4.Google Scholar
Cole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H.. Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 2000; 320: 1240–3.CrossRefGoogle ScholarPubMed
Wong, C., Marwick, T.H.. Obesity cardiomyopathy: pathogenesis and pathophysiology. Nat Clin Pract Cardiovasc Med 2007; 4: 436–43.Google Scholar
Luce, J.M.. Respiratory complications of obesity. Chest 1980; 78: 626–31.Google Scholar
Abernethy, D.R., Greenblatt, D.J.. Drug disposition in obese humans. An update. Clin Pharmacokinet 1986; 11: 199–213.Google Scholar
Anderson, B.J., Holford, N.H.. What is the best size predictor for dose in the obese child? Pediatr Anesth 2017; 27: 1176–84.CrossRefGoogle ScholarPubMed
Green, B., Duffull, S.B.. What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol 2004; 58: 119–33.CrossRefGoogle ScholarPubMed
Cortinez, L.I., Anderson, B.J., Penna, A., et al. Influence of obesity on propofol pharmacokinetics: derivation of a pharmacokinetic model. Br J Anaesth 2010; 105: 448–56.Google Scholar
Eleveld, D.J., Proost, J.H., Cortinez, L.I., Absalom, A.R., Struys, M.M.. A general purpose pharmacokinetic model for propofol. Anesth Analg 2014; 118: 1221–37.Google Scholar
Anderson, B.J., Holford, N.H.. Mechanism-based concepts of size and maturity in pharmacokinetics. Annu Rev Pharmacol Toxicol 2008; 48: 303–32.CrossRefGoogle ScholarPubMed
Du Bois, D., Du Bois, E.F.. Clinical calorimetry: tenth paper. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916; 17: 863–71.Google Scholar
James, W.. Research on Obesity. London: Her Majesty’s Stationery Office, 1976.Google Scholar
Janmahasatian, S., Duffull, S.B., Ash, S., Ward, L.C., Byrne, N.M., Green, B.. Quantification of lean bodyweight. Clin Pharmacokinet 2005; 44: 1051–65.Google Scholar
Duffull, S.B., Dooley, M.J., Green, B., Poole, S.G., Kirkpatrick, C.M.. A standard weight descriptor for dose adjustment in the obese patient. Clin Pharmacokinet 2004; 43: 1167–78.CrossRefGoogle ScholarPubMed
Pai, M.P., Paloucek, F.P.. The origin of the ‘ideal’ body weight equations. Ann Pharmacother 2000; 34: 1066–9.CrossRefGoogle ScholarPubMed
Abernethy, D.R., Greenblatt, D.J., Divoll, M., Shader, R.I.. Prolonged accumulation of diazepam in obesity. J Clin Pharmacol 1983; 23: 369–76.Google Scholar
Whitwam, J.G.. Flumazenil and midazolam in anaesthesia. Acta Anaesthesiol Scand Suppl 1995; 108: 15–22.CrossRefGoogle ScholarPubMed
Choi, Y.K., Brolin, R.E., Wagner, B.K., Chou, S., Etesham, S., Pollak, P.. Efficacy and safety of patient-controlled analgesia for morbidly obese patients following gastric bypass surgery. Obes Surg 2000; 10: 154–9.Google Scholar
Schwartz, A.E., Matteo, R.S., Ornstein, E., Halevy, J.D., Diaz, J.. Pharmacokinetics and pharmacodynamics of vecuronium in the obese surgical patient. Anesthes Analg 1992; 74: 515–18.Google Scholar
Meyhoff, C.S., Lund, J., Jenstrup, M.T., et al. Should dosing of rocuronium in obese patients be based on ideal or corrected body weight? Anesth Analg 2009; 109: 787–92.Google Scholar
Leykin, Y., Pellis, T., Lucca, M., Lomangino, G., Marzano, B., Gullo, A.. The pharmacodynamic effects of rocuronium when dosed according to real body weight or ideal body weight in morbidly obese patients. Anesth Analg 2004; 99: 1086–9.Google Scholar
Leykin, Y., Pellis, T., Lucca, M., Lomangino, G., Marzano, B., Gullo, A.. The effects of cisatracurium on morbidly obese women. Anesth Analg 2004; 99: 1090–4.CrossRefGoogle ScholarPubMed
Schnider, T.W., Minto, C.F., Gambus, P.L., et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88: 1170–82.Google Scholar
Minto, C.F., Schnider, T.W., Egan, T.D., et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997; 86: 10–23.Google Scholar
Eleveld, D.J., Proost, J.H., Vereecke, H., et al. An allometric model of remifentanil pharmacokinetics and pharmacodynamics. Anesthesiology 2017; 126: 1005–18.CrossRefGoogle ScholarPubMed
Cortinez, L.I., Anderson, B.J., Holford, N.H., et al. Dexmedetomidine pharmacokinetics in the obese. Eur J Clin Pharmacol 2015; 71: 1501–8.CrossRefGoogle ScholarPubMed
Li, J.Y., Zou, Q.R., Peng, X.M.. [Pharmacokinetics of a cisatracurium dose according to fat-free mass for anesthesia induction in morbidly obese patients]. Nan Fang Yi Ke Da Xue Xue Bao 2016; 36: 1396–400.Google Scholar
Al-Sallami, H.S., Goulding, A., Grant, A., Taylor, R., Holford, N., Duffull, S.B.. Prediction of fat-free mass in children. Clin Pharmacokinet 2015; 54: 1169–78.Google Scholar
Bauer, L.A., Edwards, W.A., Dellinger, E.P., Simonowitz, D.A.. Influence of weight on aminoglycoside pharmacokinetics in normal weight and morbidly obese patients. Eur J Clin Pharmacol 1983; 24: 643–7.Google Scholar
Collier, H., Nasim, M., Gandhi, A.. Prescribing in obese children: how good are paediatricians? Arch Dis Child 2017; 102: 61–2.CrossRefGoogle ScholarPubMed
Anderson, B.J., Holford, N.H.. Getting the dose right for obese children. Arch Dis Child 2017; 102: 54–5.CrossRefGoogle ScholarPubMed
Badaoui, R., Cabaret, A., Alami, Y., et al. Reversal of neuromuscular blockade by sugammadex in laparoscopic bariatric surgery: in support of dose reduction. Anaesth Crit Care Pain Med 2016; 35: 25–9.Google ScholarPubMed
Servin, F., Farinotti, R., Haberer, J.P., Desmonts, J.M.. Propofol infusion for maintenance of anesthesia in morbidly obese patients receiving nitrous oxide. A clinical and pharmacokinetic study. Anesthesiology 1993; 78: 657–65.CrossRefGoogle ScholarPubMed
Traynor, A.M., Nafziger, A.N., Bertino, J.S., Jr. Aminoglycoside dosing weight correction factors for patients of various body sizes. Antimicrob Agents Chemother 1995; 39: 545–8.Google Scholar
Cortinez, L.I., Anderson, B.J., Penna, A., et al. Influence of obesity on propofol pharmacokinetics: derivation of a pharmacokinetic model. Brit J Anaesth 2010; 105: 448–56.Google Scholar
Allegaert, K., Olkkola, K.T., Owens, K.H., Van de Velde, M., de Maat, M.M., Anderson, B.J.. Covariates of intravenous paracetamol pharmacokinetics in adults. BMC Anesthesiol 2014; 14: 77.Google Scholar
Holford, N.H.G., Anderson, B.J.. Allometric size: the scientific theory and extension to normal fat mass. Eur J Pharm Sci 2017; 109S: S59–S64.Google Scholar
van Kralingen, S., Diepstraten, J., Peeters, M.Y., et al. Population pharmacokinetics and pharmacodynamics of propofol in morbidly obese patients. Clin Pharmacokinet 2011; 50: 739–50.Google Scholar
Diepstraten, J., Chidambaran, V., Sadhasivam, S., et al. Propofol clearance in morbidly obese children and adolescents: influence of age and body size. Clin Pharmacokinet 2012; 51: 543–51.CrossRefGoogle ScholarPubMed
Schuttler, J., Ihmsen, H.. Population pharmacokinetics of propofol: a multicenter study. Anesthesiology 2000; 92: 727–38.CrossRefGoogle ScholarPubMed
Eleveld, D.J., Colin, P., Absalom, A.R., Struys, M.. Pharmacokinetic–pharmacodynamic model for propofol for broad application in anaesthesia and sedation. Br J Anaesth 2018; 120: 942–59.Google Scholar
Cortinez, L.I., Sepulveda, P., Rolle, A., Cottin, P., Guerrini, A., Anderson, B.J.. Effect-site target controlled infusion in the obese: model derivation and performance assessment. Anesth Analg 2018; 127: 865–72.CrossRefGoogle ScholarPubMed
Marsh, B., White, M., Morton, N., Kenny, G.N..Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth 1991; 67: 41–8.CrossRefGoogle ScholarPubMed
La Colla, L., Albertin, A., La Colla, G., et al. No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients. Eur J Anaesthesiol 2009; 26: 362–9.CrossRefGoogle ScholarPubMed
Absalom, A.R., Mani, V., De Smet, T., Struys, M.M.. Pharmacokinetic models for propofol: defining and illuminating the devil in the detail. Br J Anaesth 2009; 103: 26–37.Google Scholar
La Colla, L., Albertin, A., La Colla, G.. Pharmacokinetic model-driven remifentanil administration in the morbidly obese: the ‘critical weight’ and the ‘fictitious height’, a possible solution to an unsolved problem? Clin Pharmacokinet 2009; 48: 397–8.Google Scholar
Shibutani, K., Inchiosa, M.A., Jr., Sawada, K., Bairamian, M.. Accuracy of pharmacokinetic models for predicting plasma fentanyl concentrations in lean and obese surgical patients: derivation of dosing weight (‘pharmacokinetic mass’). Anesthesiology 2004; 101: 603–13.Google Scholar
Bouillon, T., Shafer, S.L.. Does size matter? Anesthesiology 1998; 89: 557–60.Google Scholar
Cortinez, L.I., De la Fuente, N., Eleveld, D.J., et al. Performance of propofol target-controlled infusion models in the obese: pharmacokinetic and pharmacodynamic analysis. Anesth Analg 2014; 119: 302–10.Google Scholar
Absalom, A., Kenny, G.. ‘Paedfusor’ pharmacokinetic data set. Br J Anaesth 2005; 95: 110.Google Scholar
Kataria, B.K., Ved, S.A., Nicodemus, H.F., et al. The pharmacokinetics of propofol in children using three different data analysis approaches. Anesthesiology 1994; 80: 104–22.Google Scholar
Egan, T.D., Huizinga, B., Gupta, S.K., et al. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology 1998; 89: 562–73.CrossRefGoogle ScholarPubMed
Kim, T.K., Obara, S., Egan, T.D., et al. Disposition of remifentanil in obesity: a new pharmacokinetic model incorporating the influence of body mass. Anesthesiology 2017; 126: 1019–32.Google Scholar
James, W.P.. Research on Obesity. London: Her Majesty’s Stationery Office, 1976.Google Scholar
Chrysostomou, C., Schmitt, C.G.. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol 2008; 4: 619–27.Google Scholar
Cortinez, L.I., Anderson, B.J., Holford, N.H., et al. Dexmedetomidine pharmacokinetics in the obese. Eur J Clin Pharmacol 2015; 71: 1501–8.Google Scholar
Rolle, A., Paredes, S., Cortinez, L.I., et al. Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients. Br J Anaesth 2018; 120: 969–77.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×