No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients

Luca La Colla, Andrea Albertin, Giorgio La Colla, Valerio Ceriani, Tiziana Lodi, Andrea Porta, G. Iorgio Aldegheri, Alberto Mangano, Ilias Khairallah, Isabella Fermo

Research output: Contribution to journalArticle

35 Citations (Scopus)

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 μ,gml-1 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. Eur J Anaesthesiol 26:362-369

Original languageEnglish
Pages (from-to)362-369
Number of pages8
JournalEuropean Journal of Anaesthesiology
Volume26
Issue number5
DOIs
Publication statusPublished - May 2009

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Propofol
Body Weight
Weights and Measures
Wetlands
Double-Blind Method
Electroencephalography
Anesthesia
Pharmacokinetics

Keywords

  • Anaesthesia
  • Intravenous
  • Obesity
  • Propofol

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients. / Colla, Luca La; Albertin, Andrea; Colla, Giorgio La; Ceriani, Valerio; Lodi, Tiziana; Porta, Andrea; Iorgio Aldegheri, G.; Mangano, Alberto; Khairallah, Ilias; Fermo, Isabella.

In: European Journal of Anaesthesiology, Vol. 26, No. 5, 05.2009, p. 362-369.

Research output: Contribution to journalArticle

Colla, Luca La ; Albertin, Andrea ; Colla, Giorgio La ; Ceriani, Valerio ; Lodi, Tiziana ; Porta, Andrea ; Iorgio Aldegheri, G. ; Mangano, Alberto ; Khairallah, Ilias ; Fermo, Isabella. / No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients. In: European Journal of Anaesthesiology. 2009 ; Vol. 26, No. 5. pp. 362-369.
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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 μ,gml-1 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. Eur J Anaesthesiol 26:362-369",
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T1 - No adjustment vs. adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients

AU - Colla, Luca La

AU - Albertin, Andrea

AU - Colla, Giorgio La

AU - Ceriani, Valerio

AU - Lodi, Tiziana

AU - Porta, Andrea

AU - Iorgio Aldegheri, G.

AU - Mangano, Alberto

AU - Khairallah, Ilias

AU - Fermo, Isabella

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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 μ,gml-1 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. Eur J Anaesthesiol 26:362-369

AB - 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 μ,gml-1 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. Eur J Anaesthesiol 26:362-369

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