Erschienen in:
01.11.2015 | Letter to Editor/LED Reply
Optimal Drug Dosing in the Obese—Still Many Years Ahead
verfasst von:
Ashish C. Sinha, Preet Mohinder Singh
Erschienen in:
Obesity Surgery
|
Ausgabe 11/2015
Einloggen, um Zugang zu erhalten
Excerpt
We appreciate the interest shown by Dr. Friesen in our recent review “Controversies in Perioperative Anesthetic Management of the Morbidly Obese: I Am a Surgeon, Why Should I Care?” [
1] Optimal drug dosing in patients with increasing body mass index (BMI) has always instigated much research and gradual improvements in the pharmacological models. Dr. Friesen illustrated a fine example that actually highlights one of the dilemmas clouding the understanding towards drug pharmacokinetics in the obese. We, however, only partly agree to his demonstration and think there maybe some oversimplification of facts that can lead to misinterpretation. For the same patient used as an example, who lost 40 kg after a successful bariatric surgery and who is no longer obese as her BMI dropped to 22.5 from 36.3 kg/m
2. Her estimated lean body weight as per Janmahasatian formula [
2] prior to surgery (105 kg) and after surgery (65 kg) turns out to be 55.2 and 42.2 kg, respectively. The concept of lean body weight is incorporated for drug dosing in obese to avoid overdosing. On the first instance (prior to surgery), she receives drug on the basis of lean body weight but on the second instance (post-surgery when she is no more an obese patient) would receive drug doses on the basis of actual or total body weight. So the dosing scalars being compared, i.e., lean body weight versus total body weight should not be equated as the concept for need of estimated weights hold true only in obese where drug distribution and metabolism are altered. …