Anaesthesia in obese patients, especially those with Class 3 obesity (morbid obesity, i.e., with a body mass index greater than 40) is a serious challenge for the entire surgical team, including anaesthesiology specialists.
The special circumstances surrounding the obese patient require the adaptation of equipment and techniques, including everything from the physical facilities of the operating room itself to the surgical and anaesthetic techniques that are implemented.
In addition to the handling difficulties derived from their weight and body volume, which require a specially-adapted operating room and a team that has been trained to treat this type of patient, the obese patient often presents comorbidities, depending on their degree (hypertension, diabetes mellitus, sleep apnoea-hypopnea syndrome, dyslipidaemia, arteriosclerosis, cardiovascular diseases, musculoskeletal dysfunction…) All of this can lead to a degree of chronic systemic inflammation and prothrombotic states. Additionally, it is not uncommon for anaesthesia to be more complex in obese patients due to difficulties in their airway.
These and other factors can lead the medical team to opt for total intravenous anaesthesia (TIVA).
Anaesthesia in obese patients: Drugs and TCI models for TIVA
Propofol is one of the most commonly used drugs in induction and maintenance of total intravenous anaesthesia (TIVA) in obese patients, often in combination with other drugs. If the surgical team chooses to use TIVA once the patient’s characteristics have been analysed, using a pharmacokinetic model of target-controlled infusion (TCI) will ensure that the tissue concentration of propofol and other drugs used in the anaesthesia is correct, something that is a challenge in and of itself with the obese patient due to the comorbidities that they may present, which in many cases make it difficult to calculate the target concentrations.
In fact, if any of the classic TCI models are used for propofol, the anaesthetist should perform additional adjustment calculations in the dosage, since they are usually not designed for anaesthesia in obese patients.
To avoid doing this, the arcomed Chroma pumps offer the exclusive Cortínez-Supúlveda pharmacokinetic model for the use of propofol in obese patients (up to 200 kg), which saves time in calculations and offers actual concentrations that are much better adjusted to the predicted concentrations, with their superiority to other TCI models having been demonstrated in different clinical publications.
The availability of this TCI model is one of the advanced features that the arcomed Chroma pumps offer, combined with the ease of use and versatility that characterise our pumps, so that once it has finished being used in the operating room, the same pump can be used in resuscitation or in the hospital ward by simply changing the pump’s mode using its touch screen.
At arcomed, we work non-stop to offer professionals and patients the most advanced technology, even in the most complex cases.