Accuracy of Pharmacokinetic Models for Predicting Plasma Fentanyl Concentrations in Lean and Obese Surgical Patients

2004 ◽  
Vol 101 (3) ◽  
pp. 603-613 ◽  
Author(s):  
Kinichi Shibutani ◽  
Mario A. Inchiosa ◽  
Keisuke Sawada ◽  
Mosses Bairamian
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Predictive Accuracy ◽  
Elective Surgery ◽  
Negative Relationship ◽  
Obese Patients ◽  
Pharmacokinetic Models ◽  
The Mean ◽  
Total Body

Background The currently available pharmacokinetic models for fentanyl were derived from normal weight patients and were not scaled to body weight. Their application to obese patients may cause overprediction of the plasma concentration of fentanyl. This study examined the influence of body weight on the predictive accuracy of two models (Anesthesiology 1990; 73:1091-102 and J Pharmacol Exp Ther 1987; 240:159-66). Further, we attempted to derive suggested dosing mass weights for fentanyl that improved predicted accuracy. Method Seventy patients undergoing major elective surgery with total body weight (TBW) <85 kg and body mass index <30 (Group L) and 39 patients with TBW >/=85 kg and body mass index >30 (Group O) were studied. In Group L and Group O, the mean TBW was 69 kg, and 125 kg, respectively and the mean body mass index in Group L and Group O was 24 and 44, respectively. Fentanyl infusion was used during surgery and postoperatively for analgesia. Plasma fentanyl concentrations were measured and predicted concentrations were obtained by computer simulation; 465 pairs of measured and predicted values were obtained. Results The influence of TBW on the performance errors of the original two models was examined with nonlinear regression analysis. Shafer error versus TBW showed a highly significant negative relationship (R squared = 0.689, P < 0.001); i.e., the Shafer model systematically overestimated fentanyl concentration as weight increased. The Scott and Stanski model showed greater variation (R squared = 0.303). We used the exponential equation for Shafer performance error versus TBW to derive suggested dosing weights ("pharmacokinetic mass") for obese patients. The pharmacokinetic mass versus TBW curve was essentially linear below 100 kg (with slope of 0.65) and approached a plateau above 140 kg. For patients weighing 140 to 200 kg, dosing weights of 100-108 kg are projected. Total body clearance (ml/min) showed a strong linear correlation with pharmacokinetic mass (r = 0.793; P < 0.001), whereas the relationship with TBW was nonlinear. Conclusion Actual body weight overestimates fentanyl dose requirements in obese patients. Dosing weight (pharmacokinetic mass) derived from the nonlinear relationship between prediction error and TBW proved to have a linear relationship with clearance.

scholarly journals Can Body Mass Index Affect Height Growth at Menarche among Girls Receiving Treatment for Early Puberty? A Retrospective Study in Korean Girls

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 110
Author(s):  
Sun-Jin Lee ◽  
Sun-Young Kim ◽  
Minsun Kim
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Central Precocious Puberty ◽  
Early Puberty ◽  
Time Points ◽  
Height Gain ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Gonadotropin-releasing hormone agonist (GnRHa) therapy is used to control puberty progression and it preserves height potential in patients with idiopathic central precocious puberty (ICPP). This study evaluated the correlation between weight and height gain at menarche following GnRHa treatment among girls with ICPP and relatively central early puberty (EP). We investigated height/weight trends and changes in height from diagnosis to menarche in girls with ICPP and EP treated with GnRHa. The mean difference in height (Δheight) from treatment cessation to menarche was 9.79 ± 3.53 cm. Girls were divided into girls with Δheight ≥ 9.79 cm (Group 1) and girls with Δheight < 9.79 cm (Group 2). Although near adult height was significantly higher in Group 1, the mean body mass index (BMI) and weight were significantly lower at diagnosis, treatment discontinuation, and menarche. The BMI and weight at the three time points were negatively correlated with height. Girls with higher BMI at all three time points had slower growth rates during the study period. Considering that BMI and body weight were closely related to Δheight, proper management of BMI and body weight of girls receiving early puberty treatment might contribute to growth during and after GnRHa treatment.

P373Arterial stiffness changes in patients with obesity and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Tarzimanova ◽  
V I Podzolkov ◽  
A E Bragina ◽  
M V Pisarev ◽  
R G Gataulin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Arterial Stiffness ◽  
Sinus Rhythm ◽  
Body Mass ◽  
Paroxysmal Atrial Fibrillation ◽  
Obese Patients ◽  
Waist To Hip Ratio ◽  
Group I ◽  
The Mean

Abstract Objective To study the changes in arterial stiffness in patients with obesity and paroxysmal atrial fibrillation (AF). Materials and methods The study included 82 obese patients. Forty-two of them (group I) had paroxysmal AF, their mean age was 60.9 ± 6.2 years. The control group (group II) included 40 obese patients in sinus rhythm with the mean age of 57.2 ± 6.5 years.  We studied arterial stiffness using cardio-ankle vascular index (CAVI) measured by the VaSera device (VS-1000) in all the patients. Patients from group I were evaluated after 3 days of sinus rhythm restoration and maintenance. We also measured the anthropometric indicators which included body mass index, waist circumference, abdominal sagittal diameter, waist-to-hip and waist-to-height ratios. Results There were no significant differences in body mass index between 2 groups. The waist-to-hip ratio was significantly higher in patients with obesity and paroxysmal atrial fibrillation than in obese patients in sinus rhythm and was 1.37 ± 0.09 and 0.84 ± 0.06, respectively (p = 0.002). The mean value of CAVI was 9.61 ± 1.51 and 6.42 ± 0.18 in group I and group II respectively; this difference was significant (p = 0.001). There was a strong positive correlation between CAVI and waist-to-hip ratio in the group I patients (p = 0.02). The results show that vascular stiffness is significantly higher in obesity patients with paroxysmal form AF. Conclusion Positive correlations between increased arterial stiffness and anthropometric indicators confirm the role of visceral obesity in the development of AF.

P0708ASSOCIATION OF OBESITY WITH KIDNEY CYST GROWTH IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE; RESULTS FROM KNOW-CKD COHORT DATA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chang Seong Kim ◽  
Hong Sang Choi ◽  
Eun hui Bae ◽  
Seong Kwon Ma ◽  
Soo Wan Kim
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Body Mass ◽  
Autosomal Dominant ◽  
Obese Patients ◽  
Polycystic Kidney ◽  
Autosomal Dominant Polycystic Kidney

Abstract Background and Aims Overweight or obese patients with autosomal dominant polycystic kidney disease (ADPKD) are associated with the decline of glomerular filtration rate. However, little is known about the annual rate of change in total kidney volume (TKV) in patients with ADPKD according to the body mass index (BMI) corrected by TKV and total liver volume (TLV). Method We analyzed 364 patients with ADPKD from the KoreaN Cohort Study for Outcomes in Patients with Chronic Kidney Disease. We compared the changes in TKV in less than 1-year, 2-years and 4-year follow-up from patients by dividing baseline body mass index (BMI) by 18.5 to 22.9 (normal), 23 to 24.9 (overweight), and &gt; 25 kg/m2 (obesity). Results During the 4-year follow-up period, TKV tended to increase statistically with increasing BMI (P = 0.032). Similarly, higher BMI group showed higher TKV than lower BMI group (P = 0.016). Conventional BMI is affected by TKV and TLV in advanced ADPKD patients. Therefore, we reclassified patients by corrected BMI using the adjusted body weight (body weight – TKV – TLV). Although the statistical significances between absolute value of TKV and corrected BMI groups were disappeared during the follow-up, TKV% change/year showed significantly higher in ADPKD patients with obesity among corrected BMI groups (normal; 20.2%, overweight; 17.6% and obesity; 30.6%, P for trend = 0.022) Conclusion Even after correcting the TKV and TVL, obese patients showed a high of TKV% change/year compared to non-obese patients with ADPKD.

scholarly journals The effects of three-week fasting diet on blood pressure, lipid profile and glucoregulation in extremely obese patients

2007 ◽  
Vol 135 (7-8) ◽  
pp. 440-446 ◽  
Author(s):  
Biljana Beleslin ◽  
Jasmina Ciric ◽  
Milos Zarkovic ◽  
Zorana Penezic ◽  
Svetlana Vujovic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Body Weight ◽  
Insulin Sensitivity ◽  
Lipid Profile ◽  
Body Mass ◽  
Glucose Intolerance ◽  
The Body ◽  
Obese Patients

Introduction Obesity is often accompanied by a number of complications including diabetes mellitus and cardiovascular diseases. Elevated blood pressure and lipids, as well as deterioration of glucoregulation are attributed, as the most significant factors, to development of diabetes mellitus and cardiovascular complications in obese patients. Objective The aim of our study was to evaluate the effects of a fasting diet on blood pressure, lipid profile and glucoregulatory parameters. Method We included 110 patients (33 male and 77 female; mean age 35?1 years, body weight 131.7?2.6 kg, body mass index 45.4?0.8 kg/m2) who were hospitalized for three weeks for the treatment of extreme obesity with the fasting diet. At the beginning, during, and at the end of this period, we evaluated changes in blood pressure, lipid profile, as well as parameters of glucoregulation including glycaemia, insulinaemia, and insulin sensitivity by HOMA. Oral glucose tolerance test (OGTT) was performed in all patients at the beginning and at the end of the fasting diet. Results During the fasting diet, the body weight decreased from 131.7?2.6 kg to 117.7?2.4 kg (p<0.001), the body mass index decreased from 45.4?0.8 kg/m2 to 40.8?0.8 kg/m2 (p<0.001), and both systolic and diastolic blood pressure significantly declined (143?2 vs. 132?2 mm Hg, p<0.001; 92?2 vs. 85?2 mm Hg, p<0.001). In addition, the fasting diet produced a significant decrease in total cholesterol, LDL cholesterol, triglycerides, as well as basal glycaemia and insulinaemia (p<0.001) Before the fasting diet, OGTT was normal in 76% of patients, whereas 21% of patients showed glucose intolerance, and 4% of patients diabetes mellitus. After the fasting diet, OGTT was normal in 88% of patients, whereas 12% of patients still had signs of glucose intolerance (p<0.05). In addition, insulin resistance significantly (p<0.05) increased from 54?6% to 89?13% after the fasting diet. Conclusion The three-week fasting diet in extremely obese patients produced a significant decrease and normalization of blood pressure, decrease in lipids, and improvement in glucoregulation including the increase in insulin sensitivity.

scholarly journals TRAUMATIC DISEASE PECULIARITIES COURSE, ITS DIAGNOSTICS AND TREATMENT AT POLYTRAUMA IN SUFFER OBESE PATIENTS

2019 ◽  
Vol 43 (4) ◽  
pp. 47-53
Author(s):  
S.D. Khimich ◽  
O. M. Chemerys
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Overweight And Obesity ◽  
The Body ◽  
Obese Patients ◽  
Prognostic Features ◽  
Normal Body ◽  
Significant Difference ◽  
Normal Body Weight

Abstract Introduction. It’s known that the issue of polytrauma is one of the most urgent problems of surgery, and among injured patients a special approach is required for patients with overweight and obesity of varying degrees. Purpose of the study. To study prognostic features of traumatic disease course and to improve the results of diagnostics and surgical treatment of patients with polytrauma suffer obesity. Materials and methods. Clinical material was made up of 106 patients with combined body trauma, which were divided into three groups according to body mass index. Results. The results of the research showed a significant difference in the course of traumatic disease in patients with normal body weight and obesity. In particular, in the process of diagnostics of blunt chest and abdominal trauma the frequency of application of interventional methods of diagnostics was directly proportional to the increase of body mass index. The course of traumatic disease in the obese patients had a number of characteristic features that formed the basis for the development of diagnostics and differential program of treatment. Conclusions. The results of the research showed that the course of traumatic disease in combined injury obese patients is directly proportional to the body mass index and has certain features that differentiate them from patients with normal body weight. Keywords: polytrauma, obesity, traumatic disease, diagnostics, treatment.

scholarly journals Cystás fibrosisban szenvedő nők várandóssága.

2021 ◽  
Vol 162 (28) ◽  
pp. 1129-1136
Author(s):  
László Ságodi ◽  
Enikő Sólyom ◽  
Andrea Almási ◽  
Eszter Csiszér ◽  
Gábor Nagy
Keyword(s):  
Body Mass Index ◽  
Cystic Fibrosis ◽  
Body Weight ◽  
Pregnant Women ◽  
Body Mass ◽  
Respiratory Function ◽  
Sweat Test ◽  
Premature Births ◽  
Gestational Week ◽  
The Mean

Összefoglaló. A cystás fibrosisban szenvedő betegek várható élettartama jelentősen megnőtt az utóbbi évtizedben, egyre több beteg képes saját gyermeket vállalni. Célunk a cystás fibrosisban szenvedő várandós nők perinatalis és anyai történéseinek felmérése saját eseteink és az irodalmi adatok alapján. 14, cystás fibrosisban szenvedő nő 16 várandósságáról számolunk be. Rögzítettük a várandósok életkorát, testtömegét, testmagasságát, testtömegindexét, légzésfunkciós értékeit a graviditás kezdetén és végén. Az anyai átlagéletkor szüléskor 21,6 (18–25) év volt. Az anyák graviditásának kezdetén a testmagasság átlaga 162 (150–175) cm, a testtömeg átlaga 57,6 (42–72) kg, a testtömegindex átlaga 21,4 (19,1–23,2) kg/m2 volt. A graviditás végén a testtömeg átlaga 62 (39–76) kg, a testtömegindex átlaga 23,6 (21,3–24,1) kg/m2 volt. A graviditás alatti súlygyarapodás átlaga 8 (1,5–21,5) kg volt. A légzésfunkciós értékek a graviditás kezdetén 2 betegnél voltak beszűkültek. A graviditás alatt még 2 beteg légzésfunkciós értékei csökkentek. A sikeres graviditások száma 13 volt. 1 anya kétszer szült. A koraszülések száma 1 volt. A várandósság átlagosan a 38. (34–40.) gestatiós hét után 7 esetben császármetszéssel, 6 esetben hüvelyi szüléssel fejeződött be. A vetélések száma 3 volt. Az Apgar-pontszám minden esetben normális volt. 13 gyermek közül 11-nél a verejtékteszt nem volt emelkedett. 2 gyermeknél magas verejtékértékek voltak, egyikük c.1521_1523delCTT-heterozigóta, a másiknál génmutációt nem tudtunk igazolni. A cystás fibrosisban szenvedő nők általában jól tolerálják a várandósságot az esetek többségében. A kórosan beszűkült tüdőfunkcióval, alacsony tápláltsági állapottal és cukorbetegséggel rendelkező nők nagyobb valószínűséggel számíthatnak káros következményekre. Az újszülöttek prognózisa általában jó, de számítani kell a koraszülés és a kis súllyal születés gyakoribb előfordulására. Ideális esetben a várandósságot előzetes tanácsadás útján kell megtervezni, és speciális cystás fibrosis csoportnak kell a várandósok ellátását figyelemmel kísérni, ideértve a cystás fibrosis kezelésében jártas szülészeket is. Kisszámú saját adatunk retrospektív elemzése megerősíti az irodalmi adatok tanúságait. Orv Hetil. 2021; 162(28): 1129–1136. Summary. The life expectancy of patients with cystic fibrosis has increased significantly in the last decade, with more and more patients being able to have their own children. The aim of our study was to assess the perinatal and maternal outcome of pregnant women with cystic fibrosis based on our own cases and literature data. We report 16 pregnancies in 14 women with cystic fibrosis. We recorded the age, body weight, height, body mass index, and respiratory function values of pregnant women at the beginning and end of pregnancy. The mean maternal age at childbirth was 21.6 (18–25) years. At the beginning of maternal pregnancy, the mean height was 162 (150–175) cm, the mean body weight was 57.6 (42–72) kg, and the mean body mass index was 21.4 (19.1–23.2) kg/m2. At the end of pregnancy, the mean body weight was 62 (39–76) kg and the mean body mass index was 23.6 (21.3–24.1) kg/m2. The weight gain under pregnancy was mean 8 (1.5–21.5) kg. The respiratory function values at the onset of pregnancy were narrowed in 2 patients. During pregnancy, the respiratory function values of 2 more patients decreased. The number of successful gestations was 13. A mother gave birth twice. The number of premature births was one. The pregnancy after the mean 38. (34–40.) gestational week was completed in 7 cases by cesarean section and in 6 cases by vaginal delivery. The number of miscarriages was 3. The Apgar score was normal in all cases. In 11 of 13 children, the sweat test was not elevated. 2 children had high sweat values, one of them is heterozygous with c.1521_1523delCTT, the other could not prove a gene mutation. Women with cystic fibrosis generally tolerate pregnancy well, in most cases. Women with poor lung function, low nutritional status, and diabetes are more likely to expect adverse consequences. The outcome of the newborns is good in general, but a common occurrence of premature birth and low birth weight is to be expected. Ideally, pregnancy should be planned through prior counseling and the care of pregnant women should be monitored by a specialized cystic fibrosis team, including obstetricians experienced in the treatment of cystic fibrosis. A retrospective analysis of our own small-number data confirms the evidence from the literature data. Orv Hetil. 2021; 162(28): 1129–1136.

scholarly journals The Role of Sleeve Gastrectomy on Preventing Type 2 Diabetes Mellitus

2017 ◽  
Vol 5 (3) ◽  
pp. 316-318 ◽  
Author(s):  
Serdar Olt ◽  
Sabri ÖzdaÅŸ ◽  
Mehmet Åžirik
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Body Mass Index ◽  
Type 2 Diabetes Mellitus ◽  
Body Mass ◽  
P Value ◽  
Obese Patients ◽  
The Mean

AIM: To investigate the effect of bariatric surgery on HbA1c and serum cortisol levels in morbidly obese patients without type 2 diabetes mellitus.MATERIALS AND METHODS: Twenty-nine patients who underwent sleeve gastrectomy and whose body mass index was> 40 were included in the present study. Patients' files were reviewed retrospectively. Those with diabetes mellitus and those with age <18 were excluded from the study. Pre-operative and 1-year post operative data were documented. The obtained data were analysed by SPSS statistical program.RESULTS: The mean age of the patients was 27.4 ± 8.4. 5 of the patients were male, and 24 were female. The mean body mass index of the patients was 44 ± 2.3. 1 patient [3.4%] had hypertension. Four patients [13.7%] had gastroesophageal reflux disease. The number of smokers was 7 [24.1%], and the number of alcohol users was 3 [10.3%]. There was a statistically significant decrease in HbA1c, body mass index values after operation [p value <0.01], but cortisol was not different [p value = 0.72].CONCLUSION: In this present study we found that bariatric surgery caused a significant decrease in HbA1c levels in non-diabetic patients, suggesting that bariatric surgery may prevent Type 2 Diabetes Mellitus in obese patients.

The Effective Effect-Site Propofol Concentration for Induction and Intubation with Two Pharmacokinetic Models in Morbidly Obese Patients Using Total Body Weight

2012 ◽  
Vol 115 (4) ◽  
pp. 823-829 ◽  
Author(s):  
Ghislaine C. Echevarría ◽  
María F. Elgueta ◽  
María T. Donoso ◽  
Diego A. Bugedo ◽  
Luis I. Cortínez ◽  
...  
Keyword(s):  
Body Weight ◽  
Total Body Weight ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Pharmacokinetic Models ◽  
Effect Site ◽  
Total Body

scholarly journals Towards Personalised Contrast Injection: Artificial-Intelligence-Derived Body Composition and Liver Enhancement in Computed Tomography

2021 ◽  
Vol 11 (3) ◽  
pp. 159
Author(s):  
Daan J. de Jong ◽  
Wouter B. Veldhuis ◽  
Frank J. Wessels ◽  
Bob de Vos ◽  
Pim Moeskops ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Computed Tomography ◽  
Body Mass Index ◽  
Body Weight ◽  
Body Mass ◽  
Total Body Weight ◽  
Lean Body Weight ◽  
Contrast Enhanced ◽  
Total Body ◽  
Enhanced Computed Tomography

In contrast-enhanced computed tomography, total body weight adapted contrast injection protocols have proven successful in achieving a homogeneous enhancement of vascular structures and liver parenchyma. However, because solid organs have greater perfusion than adipose tissue, the lean body weight (fat-free mass) rather than the total body weight is theorised to cause even more homogeneous enhancement. We included 102 consecutive patients who underwent a multiphase abdominal computed tomography between March 2016 and October 2019. Patients received contrast media (300 mgI/mL) according to bodyweight categories. Using regions of interest, we measured the Hounsfield unit (HU) increase in liver attenuation from unenhanced to contrast-enhanced computed tomography. Furthermore, subjective image quality was graded using a four-point Likert scale. An artificial intelligence algorithm automatically segmented and determined the body compositions and calculated the percentages of lean body weight. The hepatic enhancements were adjusted for iodine dose and iodine dose per total body weight, as well as percentage lean body weight. The associations between enhancement and total body weight, body mass index, and lean body weight were analysed using linear regression. Patients had a median age of 68 years (IQR: 58–74), a total body weight of 81 kg (IQR: 73–90), a body mass index of 26 kg/m2 (SD: ±4.2), and a lean body weight percentage of 50% (IQR: 36–55). Mean liver enhancements in the portal venous phase were 61 ± 12 HU (≤70 kg), 53 ± 10 HU (70–90 kg), and 53 ± 7 HU (≥90 kg). The majority (93%) of scans were rated as good or excellent. Regression analysis showed significant correlations between liver enhancement corrected for injected total iodine and total body weight (r = 0.53; p < 0.001) and between liver enhancement corrected for lean body weight and the percentage of lean body weight (r = 0.73; p < 0.001). Most benefits from personalising iodine injection using %LBW additive to total body weight would be achieved in patients under 90 kg. Liver enhancement is more strongly associated with the percentage of lean body weight than with the total body weight or body mass index. The observed variation in liver enhancement might be reduced by a personalised injection based on the artificial-intelligence-determined percentage of lean body weight.

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