Evaluation of Propofol Anesthesia in Morbidly Obese Children and Adolescents

Vidya Chidambaran; Senthilkumar Sadhasivam; Jeroen Diepstraten; Hope Esslinger; Shareen Cox; Beverly M Schnell; Paul Samuels; Thomas Inge; Alexander A Vinks; Catherijne A Knibbe

Disclosures

BMC Anesthesiol. 2013;13(8) 

In This Article

Background

Propofol is commonly used for total intravenous anesthesia (TIVA) due to its characteristic ease of titration, rapid onset and offset of action, reduced incidence of postoperative nausea/vomiting[1] and emergence agitation.[2] In the morbidly obese (MO) paediatric population, despite propofol's desirable characteristics, appropriate drug administration is complicated by numerous anatomic and physiological factors that accompany obesity, including increases in total body mass, blood volume, cardiac output and regional blood flow.[3] Inavailability of evidence-based clinical guidelines and an adequate dosing scalar for individualized propofol dosing in MO children and adolescents could adversely impact the quality of TIVA administered to these patients.[4]

Recent evidence has highlighted drug dosing issues in obese adults raising concerns at both extremes of drug administration: inadequate anesthesia resulting in intra-operative awareness due to under-dosing propofol[5] and excessive anesthetic administration, resulting in organ hypoperfusion and low processed electroencephalographic index values which could be associated with poor outcomes.[6–9] Although the Bispectral Index/BIS monitor provides quantifiable and continuous assessment of propofol cortical effects in children and adolescents,[10–12] it is a common to practice TIVA with propofol in children without BIS monitoring. In this descriptive study in a cohort of MO paediatric patients, we evaluated the effects of propofol TIVA on perioperative outcomes.

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