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No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients.
Eur J Anaesthesiol. 2009 May; 26(5):362-9.EJ

Abstract

BACKGROUND AND OBJECTIVE

The purpose of this prospective, randomized, double-blind study was to determine the predictive performance of target-controlled infusions of propofol in morbidly obese patients using the 'Marsh' pharmacokinetic parameter set.

METHODS

Twenty-four patients (ASA II or III, age 25-62 years, BMI 35.5-61.7) were randomly allocated to receive propofol target-controlled infusion based on a weight adjustment formula (group adjusted) or without adjustment [group total body weight (TBW)]. Anaesthesia was induced by a propofol-targeted concentration of 6 microg ml that was subsequently adapted to maintain stable bispectral index values ranging between 40 and 50. Arterial blood samples were collected before the start of the infusion and every 15 min thereafter to determine the predictive performances.

RESULTS

There were no statistically significant differences between the groups with regard to performance errors, divergence and wobble. Results are presented as median (interquartiles). Median performance error and median absolute performance error were -31.7 (-35.9, -19.4) and 31.7% (20.2, 35.9) for group adjusted and -16.3 (-26.3, 2.2) and 20.6% (14.8, 26.9) for group TBW, respectively. Wobble median value was 7.4% (3.8, 8.4) for group adjusted and 8.2% (7.0, 9.6) for group TBW. As for wobble and divergence, no statistically significant differences were found between groups.

CONCLUSION

Weight adjustment causes a clinically unacceptable performance bias, which is not corrected when TBW is used as an input to the 'Marsh' model. It is, therefore, advisable to administer propofol to morbidly obese patients by titration to targeted processed-EEG values.

Authors+Show Affiliations

Department of Anesthesiology, Vita-Salute San Raffaele University School of Medicine - IRCCS San Raffaele, Italy. l.lacolla@studenti.hsr.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19307972

Citation

La Colla, Luca, et al. "No Adjustment Vs. Adjustment Formula as Input Weight for Propofol Target-controlled Infusion in Morbidly Obese Patients." European Journal of Anaesthesiology, vol. 26, no. 5, 2009, pp. 362-9.
La Colla L, Albertin A, La Colla G, et al. No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients. Eur J Anaesthesiol. 2009;26(5):362-9.
La Colla, L., Albertin, A., La Colla, G., Ceriani, V., Lodi, T., Porta, A., Aldegheri, G., Mangano, A., Khairallah, I., & Fermo, I. (2009). No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients. European Journal of Anaesthesiology, 26(5), 362-9. https://doi.org/10.1097/EJA.0b013e328326f7d0
La Colla L, et al. No Adjustment Vs. Adjustment Formula as Input Weight for Propofol Target-controlled Infusion in Morbidly Obese Patients. Eur J Anaesthesiol. 2009;26(5):362-9. PubMed PMID: 19307972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients. AU - La Colla,Luca, AU - Albertin,Andrea, AU - La Colla,Giorgio, AU - Ceriani,Valerio, AU - Lodi,Tiziana, AU - Porta,Andrea, AU - Aldegheri,Giorgio, AU - Mangano,Alberto, AU - Khairallah,Ilias, AU - Fermo,Isabella, PY - 2009/3/25/entrez PY - 2009/3/25/pubmed PY - 2009/9/10/medline SP - 362 EP - 9 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 26 IS - 5 N2 - BACKGROUND AND OBJECTIVE: The purpose of this prospective, randomized, double-blind study was to determine the predictive performance of target-controlled infusions of propofol in morbidly obese patients using the 'Marsh' pharmacokinetic parameter set. METHODS: Twenty-four patients (ASA II or III, age 25-62 years, BMI 35.5-61.7) were randomly allocated to receive propofol target-controlled infusion based on a weight adjustment formula (group adjusted) or without adjustment [group total body weight (TBW)]. Anaesthesia was induced by a propofol-targeted concentration of 6 microg ml that was subsequently adapted to maintain stable bispectral index values ranging between 40 and 50. Arterial blood samples were collected before the start of the infusion and every 15 min thereafter to determine the predictive performances. RESULTS: There were no statistically significant differences between the groups with regard to performance errors, divergence and wobble. Results are presented as median (interquartiles). Median performance error and median absolute performance error were -31.7 (-35.9, -19.4) and 31.7% (20.2, 35.9) for group adjusted and -16.3 (-26.3, 2.2) and 20.6% (14.8, 26.9) for group TBW, respectively. Wobble median value was 7.4% (3.8, 8.4) for group adjusted and 8.2% (7.0, 9.6) for group TBW. As for wobble and divergence, no statistically significant differences were found between groups. CONCLUSION: Weight adjustment causes a clinically unacceptable performance bias, which is not corrected when TBW is used as an input to the 'Marsh' model. It is, therefore, advisable to administer propofol to morbidly obese patients by titration to targeted processed-EEG values. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/19307972/No_adjustment_vs__adjustment_formula_as_input_weight_for_propofol_target_controlled_infusion_in_morbidly_obese_patients_ L2 - https://doi.org/10.1097/EJA.0b013e328326f7d0 DB - PRIME DP - Unbound Medicine ER -