Predictive Performance of the ‘Minto’ Remifentanil Pharmacokinetic Parameter Set in Morbidly Obese Patients Ensuing from a New Method for Calculating Lean Body Mass

Colla, Luca La; Albertin, A.; Colla, G. La; Porta, Andrea; Aldegheri, Giorgio; Candia, Domenico Di; Gigli, F.

doi:10.2165/11317690-000000000-00000

Cited by 39 publications

(19 citation statements)

References 13 publications

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“…When the LBM derived from this equation is graphed against BW, an inverted parabolic function is created (13). Therefore, the LBM values start to decrease after a critical weight, leading to what is likely an underestimation of LBM and an undercorrection of SUV in obese patients (11).…”

Section: Discussionmentioning

confidence: 99%

Optimum Lean Body Formulation for Correction of Standardized Uptake Value in PET Imaging

et al. 2014

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Standardized uptake value (SUV) normalized by lean body mass ([LBM] SUL) is becoming a popular metric for quantitative assessment of clinical PET. Sex-specific quantitative effects of different LBM formulations on liver SUV have not been well studied. Methods 18F-FDG PET/CT scans from 1,033 consecutive adult (501 women, 532 men) studies were reviewed. Liver SUV was measured with a 3-cm-diameter spheric region of interest in the right hepatic lobe and corrected for LBM using the sex-specific James and Janmahasatian formulations. Results Body weight was 71.0 ± 20.7 kg (range, 18.0–175.0 kg) and 82.9 ± 18.6 kg (range, 23.0–159.0 kg) for women and men, respectively. SUV, based on body weight, has a significantly positive correlation with weight for both women (r = 0.58, P < 0.0001) and men (r = 0.54, P < 0.0001). This correlation is reduced in men (r = 0.11, P = 0.01) and becomes negative for women (r = −0.35, P = 0.0001) with the James formulation of SUL. This negative correlation was eliminated when the very obese women (body mass index ≥ 35) were excluded from the analysis (r = 0.13, P = 0.8). The Janmahasatian formulation annuls the correlation between SUL and weight for women (r = 0.04, P = 0.4) and decreases it for men (r = 0.13, P = 0.003). Conclusion Hepatic correction with the more common James formulation for body lean mass breaks down and shows low SUL values in very obese patients. The adoption of the Janmahasatian formula for estimation of LBM in modern PET scanners and display workstations is recommended, in view of the increasing frequency of obesity.

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Section: Discussionmentioning

confidence: 99%

Optimum Lean Body Formulation for Correction of Standardized Uptake Value in PET Imaging

et al. 2014

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“…However, in a follow-up study, the same authors showed a better predictive performance of the same PK parameters when the Janmahasatian equations were used. 19…”

Section: Lean Body Weightmentioning

confidence: 99%

Dose adjustment of anaesthetics in the morbidly obese

Ingrande

Lemmens

2010

British Journal of Anaesthesia

366

155

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Anaesthesiologists must be prepared to deal with pharmacokinetic and pharmacodynamic (PD) differences in morbidly obese individuals. As drug administration based on total body weight can result in overdose, weight-based dosing scalars must be considered. Conversely, administration of drugs based on ideal body weight can result in a sub-therapeutic dose. Changes in cardiac output and alterations in body composition affect the distribution of numerous anaesthetic drugs. With the exception of neuromuscular antagonists, lean body weight is the optimal dosing scalar for most drugs used in anaesthesia including opioids and anaesthetic induction agents. The increased incidence of obstructive sleep apnoea and fat deposition in the pharynx and chest wall places the morbidly obese at increased risk for adverse respiratory events secondary to anaesthetic agents, thus altering the PD properties of these drugs. Awareness of the pharmacology of the commonly used anaesthetic agents including induction agents, opioids, inhalation agents and neuromuscular blockers is necessary for safe and effective care of morbidly obese patients.

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“…As clearance is the most relevant pharmacokinetic parameter for maintenance dosing, LBW is a more relevant dosing scalar than TBW for those drugs whose clearance is linearly correlated to LBW. 3 Values obtained by the Janmahasatian equation are more accurate and have been validated with comparison to values obtained by bioimpedance scales. Dual x-ray absorptiometry, bioimpedance scales, and air/water displacement tanks remain the most accurate tools for calculating body composition.…”

Section: Increase In Body Weight and Changes In Body Compositionmentioning

confidence: 75%