Obese Kids Need Less Anesthesia, Study Finds
Obese children require much smaller doses of the anesthetic propofol than normal-weight children to bring about a safe level of unconsciousness, according to a new study.
Because the commonly used drug propofol can cause low blood pressure, prolonged sleepiness and decreased breathing, this study’s results can help anesthesiologists safely treat a common type of surgical patient that is often misunderstood.
“Little information is available to assist anesthesiologists in determining the right dose of medication to give to an obese child,” said Dr. Olutoyin A. Olutoye, of Texas Children’s Hospital in Houston, and lead author of the study.
Companies that make these medications do not specifically study their effects in this group of children before the drug is released for general use, researchers say.
Anesthesiologists now must decide whether anesthetic drug doses should be based on a child’s actual weight or lean body weight. In obese children, 75 percent of their excess body weight is comprised of fat tissue, which alters drug distribution.
“Obese adults often need a smaller dose of propofol than normal weight adults, but a correlation to children isn’t guaranteed since adults and kids handle medications differently,” said Dr. Olutoye in a news release.
For this study, 40 obese and 40 non-obese children were observed using a process called the biased coin design. This process requires fewer patients and provides greater accuracy in the calculation of dose requirements than other techniques.
After measuring each child’s response 20 seconds after the propofol was administered, researchers discovered obese children needed 2 mg/kg of propofol to bring about unconsciousness at the beginning of surgery, compared to the normal weight children who needed 50-60 percent more propofol (3.2mg/kg).
“When providing care for obese children with propofol, 95 percent of children will likely need only a smaller dose of propofol to initiate anesthesia for surgical procedures,” said Dr. Olutoye, commenting on the study‘s results.
This study is important, Dr. Olutove said, because propofol can cause low blood pressure, which can be worsened if larger-than-needed amounts are given.
Researchers say more pediatric studies are needed to determine if there are other differences in medication responses for obese and non-obese children in clinical practice.
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