Obesity Modestly Affects Inhaled Anesthetic Kinetics in Humans

Abstract

BMI modestly affects FD/FA and FI/FA, and this effect is most apparent for an anesthetic having a greater solubility in all tissues. An increased BMI increases anesthetic uptake and, thus, the need for delivered anesthetic to sustain a constant alveolar anesthetic concentration, particularly with a more soluble anesthetic. However, the increase with an increased body mass is small.

Perturbed Development of Striatal Dopamine Transporters in Fatty Versus Lean Zucker Rats: a Follow-up Small Animal PET Study

“…There were no correlation of BP ND and blood markers at baseline (correlation coefficients varied between −0.13 and 0.11), but fair to strong correlation at follow-up (correlation coefficients: 0.49 (glucose), −0.74 (triglyceride), −0.38 (cholesterol), and −0.43 (insulin); n=13-15) cl confidence limit, FZ fatty Zucker rats, LZ lean Zucker rats a Mann-Whitney U-test mass and adiposity had effects on depth of anaesthesia, this might in turn have altered the availability of DAT sites. However, we note that morbid obesity is without much effect on isoflurane kinetics in humans [25] and thus seems unlikely to be an important factor in the present comparison of DAT binding in FZ and LZ rats. The mesencephalic dopamine neurons innervating the ventral tegmental area (VTA) and also the dorsal striatum signal aspects of the rewarding properties of psychostimulants are involved in loss of control of drug intake.…”

“…These disparate findings suggest that obesity in FZ rats may increase the dynamics of DAT recycling from the plasma membrane, possibly resulting in a net decline in DAT levels, as measured by PET in the present study. However, a [ 123 I]PE2I SPECT study in 33 healthy humans did not reveal any association of striatal DAT binding with BMI (mean 30; range 21-50) [37], nor did a [ 123 I]FP-CIT SPECT study in 123 healthy subjects (BMI mean 25; range 18-41) [38], whereas a [ 99m Tc]-TRODAT-1 study in 50 volunteers did reveal a negative correlation between striatal DAT and BMI (mean 23; range [19][20][21][22][23][24][25][26][27][28][29][30] [39]; the issue may be some threshold for obesity resulting in altered DAT availability in humans, or other factors such as heterogeneity of the causes of human obesity.…”

Effects of A-Line Autoregression Index (AAI) Monitoring on Recovery After Sevoflurane Anesthesia for Bariatric Surgery

“…In obese subjects, the mass of adipose tissue amplifies the accumulation and redistribution effect of anesthetics and slows recovery further [3,4,18]. This view has been challenged in the case of newer and less lipophilic anesthetics (i.e., desflurane and sevoflurane) by findings that emergence times were similar in lean and obese patients after an anesthesia lasting 2 to 4 h [19,20]. Nevertheless, postanesthetic recovery has remained an important issue in obese patients because of their high sensitivity to anesthetics and pathological changes in the upper airway muscle, which pose risk of respiratory complications [1,2].…”

Fast wake-up time in obese patients: Which anesthetic is best?

“…Indeed, clinical trials have not shown significant clinical differences in the time to wake up between obese and nonobese patients anesthetized with inhalational agents. 7 Furthermore, the fat solubility of anesthetics has not been shown to be important to anesthetic recovery times. 8 All of the currently used inhalational anesthetics have a relatively high fat solubility.…”

“…En effet, les études cliniques n'ont pas montré de différences significatives d'un point de vue clinique en matière de temps jusqu'au réveil entre les patients obèses et non obèses anesthésiés avec des agents volatils. 7 De plus, il n'a pas été démontré que la solubilité lipidique des anesthésiques était importante en matière de temps de récupération après une anesthésie. 8 Tous les agents volatils utilisés à l'heure actuelle ont une solubilité lipidique relativement élevée.…”