Login Register Cart 0
Generic placeholder image

Current Pharmaceutical Design

Editor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Choice of Perioperative Anesthetic Medications in Patients Undergoing Bariatric Surgery

Author(s): Luiz Fernando dos Reis Falcão, Santiago Mc Loughlin and Adrian Alvarez*

Volume 25, Issue 19, 2019

Page: [2115 - 2122] Pages: 8

DOI: 10.2174/1381612825666190628161206

Price: $65

Abstract

The prevalence of obesity is increasing globally. Rational perioperative anesthetic drug selection and administration require knowledge of how obesity interacts with those drugs. In this review, we summarize different aspects of the anesthetic agents, including pharmacokinetics (PK), pharmacodynamics (PD) and clinical application of the most commonly used medications with particular focus on the enhanced recovery of the obese patient.

Keywords: Bariatric surgery, obesity, pharmacokinetics, pharmacodynamics, enhanced recovery, analgesia.

« Previous Next »
[1]
Piché ME, Poirier P, Lemieux I, Després JP. Overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease: An update. Prog Cardiovasc Dis 2018; 61(2): 103-13.
[http://dx.doi.org/10.1016/j.pcad.2018.06.004] [PMID: 29964067]
[2]
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945): 766-81.
[http://dx.doi.org/10.1016/S0140-6736(14)60460-8] [PMID: 24880830]
[3]
About obesity. World Obesity Federation, 2017. Available from: www.worldobesity.org/about/about-obesity.
[4]
Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii, 1-253.
[PMID: 11234459]
[5]
Wormser D, Kaptoge S, Di Angelantonio E, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies. Lancet 2011; 377(9771): 1085-95.
[http://dx.doi.org/10.1016/S0140-6736(11)60105-0] [PMID: 21397319]
[6]
Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic burden of obesity: A systematic literature review. Int J Environ Res Public Health 2017; 14(4): 14.
[http://dx.doi.org/10.3390/ijerph14040435] [PMID: 28422077]
[7]
Smith BR, Schauer P, Nguyen NT. Surgical approaches to the treatment of obesity: Bariatric surgery. Endocrinol Metab Clin North Am 2008; 37(4): 943-64.
[http://dx.doi.org/10.1016/j.ecl.2008.08.001] [PMID: 19026941]
[8]
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357(8): 741-52.
[http://dx.doi.org/10.1056/NEJMoa066254] [PMID: 17715408]
[9]
Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: Enhanced recovery after surgery (ERAS) society recommendations. World J Surg 2016; 40(9): 2065-83.
[http://dx.doi.org/10.1007/s00268-016-3492-3] [PMID: 26943657]
[10]
Ahmed OS, Rogers AC, Bolger JC, Mastrosimone A, Robb WB. Meta-analysis of enhanced recovery protocols in bariatric surgery. J Gastrointest Surg 2018; 22(6): 964-72.
[http://dx.doi.org/10.1007/s11605-018-3709-x] [PMID: 29488124]
[11]
Małczak P, Pisarska M, Piotr M, Wysocki M, Budzyński A, Pędziwiatr M. Enhanced recovery after bariatric surgery: Systematic review and meta-analysis. Obes Surg 2017; 27(1): 226-35.
[http://dx.doi.org/10.1007/s11695-016-2438-z] [PMID: 27817086]
[12]
Wang W, Yang C, Wang B. [Meta-analysis on safety of application of enhanced recovery after surgery to laparoscopic bariatric surgery] Zhonghua Wei Chang Wai Ke Za Zhi 2018; 21(10): 1167-74.
[PMID: 30370517]
[13]
De Baerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesthesiol 2016; 29(1): 119-28.
[http://dx.doi.org/10.1097/ACO.0000000000000286] [PMID: 26658181]
[14]
Pai MP, Paloucek FP. The origin of the “ideal” body weight equations. Ann Pharmacother 2000; 34(9): 1066-9.
[http://dx.doi.org/10.1345/aph.19381] [PMID: 10981254]
[15]
Lemmens HJ. Perioperative pharmacology in morbid obesity. Curr Opin Anaesthesiol 2010; 23(4): 485-91.
[http://dx.doi.org/10.1097/ACO.0b013e32833b0a8c] [PMID: 20531173]
[16]
Cheymol G. Effects of obesity on pharmacokinetics implications for drug therapy. Clin Pharmacokinet 2000; 39(3): 215-31.
[http://dx.doi.org/10.2165/00003088-200039030-00004] [PMID: 11020136]
[17]
Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth 2000; 85(1): 91-108.
[http://dx.doi.org/10.1093/bja/85.1.91] [PMID: 10927998]
[18]
Kotlyar M, Carson SW. Effects of obesity on the cytochrome P450 enzyme system. Int J Clin Pharmacol Ther 1999; 37(1): 8-19.
[PMID: 10027478]
[19]
Brill MJ, Diepstraten J, van Rongen A, van Kralingen S, van den Anker JN, Knibbe CA. Impact of obesity on drug metabolism and elimination in adults and children. Clin Pharmacokinet 2012; 51(5): 277-304.
[http://dx.doi.org/10.2165/11599410-000000000-00000] [PMID: 22448619]
[20]
Henegar JR, Bigler SA, Henegar LK, Tyagi SC, Hall JE. Functional and structural changes in the kidney in the early stages of obesity. J Am Soc Nephrol 2001; 12(6): 1211-7.
[PMID: 11373344]
[21]
Hanley MJ, Abernethy DR, Greenblatt DJ. Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet 2010; 49(2): 71-87.
[http://dx.doi.org/10.2165/11318100-000000000-00000] [PMID: 20067334]
[22]
Huttunen R, Syrjänen J. Obesity and the risk and outcome of infection. Int J Obes 2013; 37(3): 333-40.
[http://dx.doi.org/10.1038/ijo.2012.62] [PMID: 22546772]
[23]
van Kralingen S, Diepstraten J, Peeters MY, et al. Population pharmacokinetics and pharmacodynamics of propofol in morbidly obese patients. Clin Pharmacokinet 2011; 50(11): 739-50.
[http://dx.doi.org/10.2165/11592890-000000000-00000] [PMID: 21973271]
[24]
Dong D, Peng X, Liu J, Qian H, Li J, Wu B. Morbid obesity alters both pharmacokinetics and pharmacodynamics of propofol: Dosing recommendation for anesthesia induction. Drug Metab Dispos 2016; 44(10): 1579-83.
[http://dx.doi.org/10.1124/dmd.116.071605] [PMID: 27481855]
[25]
Ingrande J, Brodsky JB, Lemmens HJ. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg 2011; 113(1): 57-62.
[http://dx.doi.org/10.1213/ANE.0b013e3181f6d9c0] [PMID: 20861415]
[26]
Servin F, Farinotti R, Haberer JP, Desmonts JM. Propofol infusion for maintenance of anesthesia in morbidly obese patients receiving nitrous oxide. A clinical and pharmacokinetic study. Anesthesiology 1993; 78(4): 657-65.
[http://dx.doi.org/10.1097/00000542-199304000-00008] [PMID: 8466066]
[27]
Eleveld DJ, Proost JH, Cortínez LI, Absalom AR, Struys MM. A general purpose pharmacokinetic model for propofol. Anesth Analg 2014; 118(6): 1221-37.
[http://dx.doi.org/10.1213/ANE.0000000000000165] [PMID: 24722258]
[28]
Cortínez LI, De la Fuente N, Eleveld DJ, et al. Performance of propofol target-controlled infusion models in the obese: Pharmacokinetic and pharmacodynamic analysis. Anesth Analg 2014; 119(2): 302-10.
[http://dx.doi.org/10.1213/ANE.0000000000000317] [PMID: 24977639]
[29]
Favetta P, Degoute CS, Perdrix JP, Dufresne C, Boulieu R, Guitton J. Propofol metabolites in man following propofol induction and maintenance. Br J Anaesth 2002; 88(5): 653-8.
[http://dx.doi.org/10.1093/bja/88.5.653] [PMID: 12067002]
[30]
Lehavi A, Sandler O, Mahajna A, Weissman A, Katz YS. Comparison of Rhabdomyolysis Markers in Patients Undergoing Bariatric Surgery with Propofol and Inhalation-based Anesthesia. Obes Surg 2015; 25(10): 1923-7.
[http://dx.doi.org/10.1007/s11695-015-1626-6] [PMID: 25716126]
[31]
Morel J, Salard M, Castelain C, et al. Haemodynamic consequences of etomidate administration in elective cardiac surgery: A randomized double-blinded study. Br J Anaesth 2011; 107(4): 503-9.
[http://dx.doi.org/10.1093/bja/aer169] [PMID: 21685487]
[32]
Ehrman R, Wira C, Lomax A, et al. Etomidate use in severe sepsis and septic shock patients does not contribute to mortality. Intern Emerg Med 2011; 6(3): 253-7.
[http://dx.doi.org/10.1007/s11739-011-0553-3] [PMID: 21394520]
[33]
Vanlinthout LE, van Egmond J, de Boo T, Lerou JG, Wevers RA, Booij LH. Factors affecting magnitude and time course of neuromuscular block produced by suxamethonium. Br J Anaesth 1992; 69(1): 29-35.
[http://dx.doi.org/10.1093/bja/69.1.29] [PMID: 1637599]
[34]
Szalados JE, Donati F, Bevan DR. Nitrous oxide potentiates succinylcholine neuromuscular blockade in humans. Anesth Analg 1991; 72(1): 18-21.
[http://dx.doi.org/10.1213/00000539-199101000-00004] [PMID: 1845791]
[35]
Bentley JB, Borel JD, Vaughan RW, Gandolfi AJ. Weight, pseudocholinesterase activity, and succinylcholine requirement. Anesthesiology 1982; 57(1): 48-9.
[http://dx.doi.org/10.1097/00000542-198207000-00014] [PMID: 7091721]
[36]
Lemmens HJ, Brodsky JB. The dose of succinylcholine in morbid obesity. Anesth Analg 2006; 102(2): 438-42.
[http://dx.doi.org/10.1213/01.ane.0000194876.00551.0e] [PMID: 16428539]
[37]
Mirakhur RK. Sugammadex in clinical practice. Anaesthesia 2009; 64(Suppl. 1): 45-54.
[http://dx.doi.org/10.1111/j.1365-2044.2008.05870.x] [PMID: 19222431]
[38]
Kim YH. Repeat dosing of rocuronium-sugammadex: Unpredictable. Korean J Anesthesiol 2014; 67(1): 1-3.
[http://dx.doi.org/10.4097/kjae.2014.67.1.1] [PMID: 25097730]
[39]
Van Lancker P, Dillemans B, Bogaert T, Mulier JP, De Kock M, Haspeslagh M. Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients. Anaesthesia 2011; 66(8): 721-5.
[http://dx.doi.org/10.1111/j.1365-2044.2011.06782.x] [PMID: 21692760]
[40]
Loupec T, Frasca D, Rousseau N, Faure JP, Mimoz O, Debaene B. Appropriate dosing of sugammadex to reverse deep rocuronium-induced neuromuscular blockade in morbidly obese patients. Anaesthesia 2016; 71(3): 265-72.
[http://dx.doi.org/10.1111/anae.13344] [PMID: 26685122]
[41]
Llauradó S, Sabaté A, Ferreres E, Camprubí I, Cabrera A. Sugammadex ideal body weight dose adjusted by level of neuromuscular blockade in laparoscopic bariatric surgery. Anesthesiology 2012; 117(1): 93-8.
[http://dx.doi.org/10.1097/ALN.0b013e3182580409] [PMID: 22549697]
[42]
Gaszynski T, Szewczyk T, Gaszynski W. Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia. Br J Anaesth 2012; 108(2): 236-9.
[http://dx.doi.org/10.1093/bja/aer330] [PMID: 22012861]
[43]
Cammu G, de Kam PJ, De Graeve K, et al. Repeat dosing of rocuronium 1.2 mg kg-1 after reversal of neuromuscular block by sugammadex 4.0 mg kg-1 in anaesthetized healthy volunteers: A modelling-based pilot study. Br J Anaesth 2010; 105(4): 487-92.
[http://dx.doi.org/10.1093/bja/aeq167] [PMID: 20630888]
[44]
Albrecht E, Kirkham KR, Liu SS, Brull R. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: A meta-analysis. Anaesthesia 2013; 68(1): 79-90.
[http://dx.doi.org/10.1111/j.1365-2044.2012.07335.x] [PMID: 23121612]
[45]
Ryu JH, Kang MH, Park KS, Do SH. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth 2008; 100(3): 397-403.
[http://dx.doi.org/10.1093/bja/aem407] [PMID: 18276652]
[46]
Katznelson R, Fisher JA. Fast wake-up time in obese patients: Which anesthetic is best? Can J Anaesth 2015; 62(8): 847-51.
[http://dx.doi.org/10.1007/s12630-015-0406-z] [PMID: 26041690]
[47]
Singh PM, Borle A, McGavin J, Trikha A, Sinha A. Comparison of the recovery profile between desflurane and sevoflurane in patients undergoing bariatric surgery-a meta-analysis of randomized controlled trials. Obes Surg 2017; 27(11): 3031-9.
[http://dx.doi.org/10.1007/s11695-017-2929-6] [PMID: 28916989]
[48]
Gaszyński T, Wieczorek A. A comparison of BIS recordings during propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia in obese patients. Anaesthesiol Intensive Ther 2016; 48(4): 239-47.
[PMID: 27797096]
[49]
Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J. Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 2008; 107(1): 138-43.
[http://dx.doi.org/10.1213/ane.0b013e318174df8b] [PMID: 18635479]
[50]
Alvarez A, Goudra BG, Singh PM. Enhanced recovery after bariatric surgery. Curr Opin Anaesthesiol 2017; 30(1): 133-9.
[PMID: 27820740]
[51]
Alvarez A, Singh PM, Sinha AC. Postoperative analgesia in morbid obesity. Obes Surg 2014; 24(4): 652-9.
[http://dx.doi.org/10.1007/s11695-014-1185-2] [PMID: 24431032]
[52]
Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res 2014; 8(3): 283-90.
[http://dx.doi.org/10.4103/0259-1162.143110] [PMID: 25886322]
[53]
Niesters M, Martini C, Dahan A. Ketamine for chronic pain: Risks and benefits. Br J Clin Pharmacol 2014; 77(2): 357-67.
[http://dx.doi.org/10.1111/bcp.12094] [PMID: 23432384]
[54]
Davies KE, Houghton K, Montgomery JE. Obesity and day-case surgery. Anaesthesia 2001; 56(11): 1112-5.
[http://dx.doi.org/10.1046/j.1365-2044.2001.01962-5.x] [PMID: 11703247]
[55]
American society of anesthesiologists task force on perioperative management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 2014; 120(2): 268-86.
[http://dx.doi.org/10.1097/ALN.0000000000000053] [PMID: 24346178]

Rights & Permissions Print Cite
Article Metrics
30
3
1
1
© 2024 Bentham Science Publishers | Privacy Policy