Anaesthetics – dose adjustments

19 Dec
Dose adjustment of anaesthetics in the morbidly obese. (J. Ingrande, H. Lemmens)
Propofol-induction: LBW
Etomidate-induction: LBW
Fentanyl: LBW (dame for sufentanil and remifentanil)
Morfine: IBW
Succinylcholine: TBW (in obesity more pseudochlinesterase so more rapid brake down)
Rocuronium: IBW (/LBW)
Midazolam-induction: TBW
Here: propofol: TBW, opposed to I/LBW in other references.
How Should Obesity be Measured and How Should Anesthetic Drug Dosage be Calculated?
And: Pharmacokinetics in obese patients. (both from L De Baerdemaeker)
LBW equations of Janmahasatian:
Males: 9270 x TBW/(6680 + 216 x BMI)
Females: 9270 x TBW/(8780 + 244 x BMI)
Propofol Induction: IBW
Maintenance: TBW or IBW + (0.4 × excess weight)
Fentanyl TBW
Corrected weight = IBW + (0.4 × excess weight)
Thiopental 7.5 mg kg−1 IBW
Midazolam TBW for initial dose
IBW for continuous dose
Vecuronium IBW
Atracurium TBW
Initial dose 0.15 mg/kg–2.3 mg/10 kg >70 kg. Supplemental dose 0.15 mg/kg–0.7 mg/10 kg >70 kg
Cisatracurium TBW
Rocuronium IBW
Succinylcholine TBW
>140 kg. Maximum 120–140 mg
Mivacurium TBW. Divided dosing 0.15 mg/kg + after 30 s 0.15 mg/kg
Neostigmine TBW
Alfentanil IBW or corrected weight
Sufentanil TBW corrected weight BMI > 40
Remifentanil IBW
Morphine IBW
Paracetamol IBW



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