oa Southern African Journal of Anaesthesia and Analgesia - Dose scaling for the morbidly obese : SASA refresher course texts
It has long been realised that linear dosing according to total body weight (TBW) results in oversdosing the obese and underdosing small children. As far back as 1969, in a study on induction doses of thiopentone, Wulfsohn and Joshi concluded that thiopentone was better administered according to lean body mass (LBM) than TBW. They reasoned that endomorphic somatotypes required less thiopentone than mesomophs and ectomorphs of the same TBW, because they had less LBM. They pointed out that there is a strong association between LBM, cardiac output and basal metabolic rate, and suggested that the LBM contained the "pharmacologically active mass". Recently, several publications have emerged that suggest that dosing of other anaesthetic drugs to obese patients, such as remifentanil and propofol, should be based on LBM.
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