Perioperative pharmacology in morbid obesity

Lemmens, Hendrikus J. M.

doi:10.1097/aco.0b013e32833b0a8c

Cited by 68 publications

(59 citation statements)

References 36 publications

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“…Indeed, the rising rate of obesity is a key factor in current projections for the United States that by 2030 the number of THAs will increase by 174% to nearly 600,000 procedures per year [17]. Pharmacokinetics, respiratory and cardiac physiology, monitoring, and postoperative care are all profoundly affected by increased body mass; thus, the increasing number of obese patients undergoing THA have increased risk for postoperative complications [18,25].…”

Section: Introductionmentioning

confidence: 99%

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Motaghedi

Bae

Memtsoudis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The prevalence of obesity is increasing, and obesity often leads to degenerative joint disease requiring total hip arthroplasty (THA). Obesity is a proinflammatory state associated with an increase in chronic, low-grade inflammatory response. As such, it may augment the postoperative inflammatory response, which has been associated with postoperative pain and complications.Questions/purposes We determined whether severity of obesity was associated with (1) severity of inflammatory response, as measured by the in vivo circulating levels of cytokines and ex vivo functional reactivity of mononuclear blood cells, and (2) severity of pain, as measured by verbal pain scores and analgesic consumption, in the first 24 hours after THA. Methods We studied 60 patients (20 normal weight, 20 overweight, 20 obese) undergoing elective primary unilateral THA in this prospective cross-sectional study. Blood samples were collected for C-reactive protein and cytokine levels, including IL-1b, IL-2, IL-6, IL-8, and tumor necrosis factor a (TNF-a), from patients before and 24 hours after surgery. Cytokine response of whole blood was evaluated ex vivo with or without two standard activators, phorbol-12-myristate-13-acetate and lipopolysaccharide, using standardized blood sample from patients at 24 hours. These standard immune activators are implicated in the inflammatory response to gram-negative infection, translocation of microbial products, pathophysiology of septic shock syndrome in human, and tumor promotion. Pain response was gauged using verbal pain scores (on a 0-to 10-point scale, where 0 = no pain and 10 = worst pain) at rest and with activity at 24 hours after surgery and analgesic

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Section: Introductionmentioning

confidence: 99%

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Motaghedi

Bae

Memtsoudis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…İnhalasyon ajanları yağda yüksek oranda çözündükleri için obez hastalarda derlenme yavaş olmaktadır. Yağ dokusundaki kan akımı azaldığından dolayı da inhalasyon ajanlarının yağ dokusundan salınımı sınırlıdır 27 .…”

Section: İlaç Seçimiunclassified

Obezite Hastalarında Anestezi Yönetimi

Uludağ¹,

Türktan²

2016

Arşiv Kaynak Tarama Dergisi

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Obesity has become a rapidly growing public health problem in whole world. Obesity and alterations due to obesity which include changes in metabolic, cardiovascular and pulmonary functions increase risk of perioperative mortality and morbidity. Obesity impacts anesthesia procedures significantly. Comorbid diseases such as hypertension, coronary artery disease, diabetes mellitus, and pulmonary diseases increase risk of complications during anesthesia. In this review we evaluated important factors that should be considered during planning of anesthesia for obesity surgery and other surgeries, management of intraoperative anesthesia and postoperative analgesia, and management of complications. Key words: Obesity, anesthesia management. ÖZETObezite, tüm dünyada giderek artan bir toplum sağlığı sorunu haline gelmiştir. Obezite ve obeziteye bağlı ortaya çıkan metabolik, kardiyovasküler ve pulmoner fonksiyonlar üzerinde değişiklikler, perioperatif mortalite ve morbidite riskini arttıran nedenlerdir. Obezite, anestezi uygulamalarını önemli ölçüde etkilemektedir. Vücut ağırlığının artması ile birlikte hava yolu yönetiminin zorlaşması başta olmak üzere hipertansiyon, koroner arter hastalıkları, diabetes mellitus, solunum yolu hastalıkları gibi yandaş hastalıklar anestezi riskini artırmaktadır. Bu derlemede; anestezi pratiğinde obezite cerrahisinde ve obezite dışı diğer cerrahilerde gün geçtikçe artan sayıda karşılaştığımız obez hasta popülasyonunda preoperatif anestezi planlamasında dikkat edilmesi gereken hususlar, intraoperatif anestezi yönetimi, postoperatif analjezi ve komplikasyonlar güncel bilgiler ışığında sunulmuştur. Anahtar kelimeler: Obezite, anestezi yönetimi.

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“…La obesidad modifica la farmacocinética y la farmacodinamia de las drogas anestésicas debido a un aumento del gasto cardiaco, de la masa magra, del tejido graso y del volumen extracelular 7 .…”

Section: Introductionunclassified

“…Se ha sugerido que las dosis de rocuronio en obesos sean calculadas en base al peso ideal 7,8,11,14,16 pero esta recomendación está basada más bien en la prudencia que en la evidencia científica 17 . Por esta razón, se decidió diseñar un estudio con el objetivo de comparar el comportamiento del rocuronio al administrarlo en base a peso real (TBW) y a peso ideal (IBW) en pacientes obesos.…”

Section: Introductionunclassified

Rocuronio en obesos: ¿Debe dosificarse por peso real o peso ideal?

Ojeda¹,

Gazabatt²,

Bustamante³

et al. 2014

Rev Chil Anest

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resumenEl aumento universal en la prevalencia de obesidad ha causado que los anestesiólogos se vean frecuentemente enfrentados a anestesiar pacientes obesos. Pese a esto aún existen dudas respecto a cómo dosificar las drogas en estos pacientes. La literatura recomienda dosificar el rocuronio en obesos en base al peso ideal (IBW, iniciales del inglés Ideal Body Weight) pero esta sugerencia está basada más bien en la prudencia que en la evidencia. Se decidió explorar con análisis de sobrevida (análisis tiempo-evento), la duración del rocuronio en obesos al ser dosificado por peso ideal (IBW) y por peso real (TBW, iniciales del inglés de peso corporal total). Al administrar el rocuronio en base al peso real (TBW) se observó una prolongación en su duración de acción con un acortamiento de su latencia en relación con la dosificación en base al peso ideal (IBW). Hubo una marcada prolongación de la duración de acción y el índice de recuperación tanto al dosificar por peso real como peso ideal. Debido a esta sensibilidad aumentada al rocuronio en pacientes obesos recomendamos dosificarlo en base al peso ideal, excepto si se necesita intubar rápidamente. AbstractThe universal increase in prevalence of obesity has caused that anesthesiologist are frequently encountered with anesthetizing obese patients. There stills exists doubt on how to dosage drugs to these patients. Literature recommends dosing rocuronium in the obese based on ideal weight (IBW), being this suggestion based more on prudence than on evidence. Randomized control trial was designed for obese patients scheduled for bariatric surgery to study the pharmacodynamics of rocuronium in this population. Patients were randomly assigned into two groups: rocuronium dosage 0.6 mg·kg -1 for real weight (TBW) or rocuronium dosage of 0.6 mg·kg -1 for ideal weight (IBW). Ideal weight was calculated according to Lemmens formula. The reference group was the dosage based on IBW. Previous calibration, evaluating the first twitch of train-of-four (T 1 ), we registered onset time, clinical duration, recovery index, level of muscle relaxation to which the first reinforcement was administered and clinical duration of rocuronium reinforcement. A total of 100 patients were part of the study: 54 in group TBW and 46 in group IBW. When administering rocuronium based on real weight (TBW) a prolongation in clinical duration was found: Medium (IQR*); 79.5 (67 -105) minutes versus 44.5 (33 -63.5 minutes) in the IBW group (p < 0.001) with a decrease in latency in the TBW group 120 (90-150 secs.) versus the IBW group 180 (120 -270 secs.) (p < 0.001). There were no differences in the recovery index between both levels of dosing. There was a marked prolongation of both clinical duration and recovery index in both groups, as supported in some literature. Based on the evidence, we recommend to dose rocuronium in obese patients based on ideal weight, with the exception of cases were quick intubation is required.* IQR = interquartile range.

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Perioperative pharmacology in morbid obesity

Abstract: For the induction dose of hypnotics and the initial dose of other drugs that have a fast onset of effect, cardiac output or LBW are relevant dosing scalars. For maintenance dosing, LBW seems to be a more appropriate dosing scalar than total body weight.

Cited by 68 publications

References 36 publications

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Obezite Hastalarında Anestezi Yönetimi

Rocuronio en obesos: ¿Debe dosificarse por peso real o peso ideal?

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