• DOI:10.1093/bja/aeq312
• Corpus ID: 9294638

Dose adjustment of anaesthetics in the morbidly obese.

@article{Ingrande2010DoseAO,
  title={Dose adjustment of anaesthetics in the morbidly obese.},
  author={Jerry Ingrande and Hendrikus J. M. Lemmens},
  journal={British journal of anaesthesia},
  year={2010},
  volume={105 Suppl 1},
  pages={
          i16-23
        }
}

• J. Ingrande, H. Lemmens
• Published 1 December 2010
• Medicine, Biology
• British journal of anaesthesia

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.