The effect of obesity on the ed95 of propofol for loss of consciousness in children and adolescents

Olutoyin A. Olutoye, Xiaoying Yu, Kalyani Govindan, Imelda M. Tjia, Deborah L. East, Renee Spearman, Priscilla J. Garcia, Crystal Coulter-Nava, Jennifer Needham, Stephanie Abrams, Claudia A. Kozinetz, Dean B. Andropoulos, Mehernoor F. Watcha

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

INTRODUCTION:: Anesthesiologists face a dilemma in determining appropriate dosing of anesthetic drugs in obese children. In this study we determined the dose of propofol that caused loss of consciousness in 95% (ED95) of obese and nonobese children as determined by loss of eye lash reflex. METHODS:: Forty obese (body mass index [BMI] > 95th percentile for age and gender) and 40 normal weight (BMI 25th to 84th percentile) healthy ASA 1 to 2 children ages 3 to 17 years presenting for surgical procedures were studied using a biased coin design. The primary endpoint was loss of lash reflex at 20 seconds after propofol administration. The first patient in each group received 1.0 mg/kg of IV propofol, and subsequent patients received predetermined propofol doses based on the lash reflex response in the previous patient. If the lash reflex was present, the next patient received a dose increment of 0.25 mg/kg. If the lash reflex was absent, the next patient was randomized to receive either the same dose (95% probability) or a dose decrement of 0.25 mg/kg (5% probability). The ED95 and 95% confidence intervals (CI) were calculated using isotonic regression and bootstrapping methods respectively. RESULTS:: The ED95 of propofol for loss of lash reflex was significantly lower in obese pediatric patients (2.0 mg/kg, approximate 95% CI, 1.8 to 2.2 mg/kg) in comparison with nonobese patients (3.2 mg/kg, approximate 95% CI, 2.7 to 3.2 mg/kg), P ≤ 0.05. DISCUSSION:: A simple approach to deciding what dose of propofol should be used for induction of anesthesia in children ages 3 to 17 years is to first establish the child's BMI on readily available gender-specific charts. Obese children (BMI >95th percentile for age and gender) require a lower weight-based dose of propofol for induction of anesthesia, than do normal-weight children.

Original languageEnglish (US)
Pages (from-to)147-153
Number of pages7
JournalAnesthesia and Analgesia
Volume115
Issue number1
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Unconsciousness
Propofol
Obesity
Reflex
Body Mass Index
Confidence Intervals
Weights and Measures
Anesthesia
Abnormal Reflexes
Numismatics
Anesthetics
Pediatrics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Olutoye, O. A., Yu, X., Govindan, K., Tjia, I. M., East, D. L., Spearman, R., ... Watcha, M. F. (2012). The effect of obesity on the ed95 of propofol for loss of consciousness in children and adolescents. Anesthesia and Analgesia, 115(1), 147-153. https://doi.org/10.1213/ANE.0b013e318256858f

The effect of obesity on the ed95 of propofol for loss of consciousness in children and adolescents. / Olutoye, Olutoyin A.; Yu, Xiaoying; Govindan, Kalyani; Tjia, Imelda M.; East, Deborah L.; Spearman, Renee; Garcia, Priscilla J.; Coulter-Nava, Crystal; Needham, Jennifer; Abrams, Stephanie; Kozinetz, Claudia A.; Andropoulos, Dean B.; Watcha, Mehernoor F.

In: Anesthesia and Analgesia, Vol. 115, No. 1, 07.2012, p. 147-153.

Research output: Contribution to journalArticle

Olutoye, OA, Yu, X, Govindan, K, Tjia, IM, East, DL, Spearman, R, Garcia, PJ, Coulter-Nava, C, Needham, J, Abrams, S, Kozinetz, CA, Andropoulos, DB & Watcha, MF 2012, 'The effect of obesity on the ed95 of propofol for loss of consciousness in children and adolescents', Anesthesia and Analgesia, vol. 115, no. 1, pp. 147-153. https://doi.org/10.1213/ANE.0b013e318256858f
Olutoye, Olutoyin A. ; Yu, Xiaoying ; Govindan, Kalyani ; Tjia, Imelda M. ; East, Deborah L. ; Spearman, Renee ; Garcia, Priscilla J. ; Coulter-Nava, Crystal ; Needham, Jennifer ; Abrams, Stephanie ; Kozinetz, Claudia A. ; Andropoulos, Dean B. ; Watcha, Mehernoor F. / The effect of obesity on the ed95 of propofol for loss of consciousness in children and adolescents. In: Anesthesia and Analgesia. 2012 ; Vol. 115, No. 1. pp. 147-153.
@article{9dd95964f3de4c8a8ef44b8cead16ae1,
title = "The effect of obesity on the ed95 of propofol for loss of consciousness in children and adolescents",
abstract = "INTRODUCTION:: Anesthesiologists face a dilemma in determining appropriate dosing of anesthetic drugs in obese children. In this study we determined the dose of propofol that caused loss of consciousness in 95{\%} (ED95) of obese and nonobese children as determined by loss of eye lash reflex. METHODS:: Forty obese (body mass index [BMI] > 95th percentile for age and gender) and 40 normal weight (BMI 25th to 84th percentile) healthy ASA 1 to 2 children ages 3 to 17 years presenting for surgical procedures were studied using a biased coin design. The primary endpoint was loss of lash reflex at 20 seconds after propofol administration. The first patient in each group received 1.0 mg/kg of IV propofol, and subsequent patients received predetermined propofol doses based on the lash reflex response in the previous patient. If the lash reflex was present, the next patient received a dose increment of 0.25 mg/kg. If the lash reflex was absent, the next patient was randomized to receive either the same dose (95{\%} probability) or a dose decrement of 0.25 mg/kg (5{\%} probability). The ED95 and 95{\%} confidence intervals (CI) were calculated using isotonic regression and bootstrapping methods respectively. RESULTS:: The ED95 of propofol for loss of lash reflex was significantly lower in obese pediatric patients (2.0 mg/kg, approximate 95{\%} CI, 1.8 to 2.2 mg/kg) in comparison with nonobese patients (3.2 mg/kg, approximate 95{\%} CI, 2.7 to 3.2 mg/kg), P ≤ 0.05. DISCUSSION:: A simple approach to deciding what dose of propofol should be used for induction of anesthesia in children ages 3 to 17 years is to first establish the child's BMI on readily available gender-specific charts. Obese children (BMI >95th percentile for age and gender) require a lower weight-based dose of propofol for induction of anesthesia, than do normal-weight children.",
author = "Olutoye, {Olutoyin A.} and Xiaoying Yu and Kalyani Govindan and Tjia, {Imelda M.} and East, {Deborah L.} and Renee Spearman and Garcia, {Priscilla J.} and Crystal Coulter-Nava and Jennifer Needham and Stephanie Abrams and Kozinetz, {Claudia A.} and Andropoulos, {Dean B.} and Watcha, {Mehernoor F.}",
year = "2012",
month = "7",
doi = "10.1213/ANE.0b013e318256858f",
language = "English (US)",
volume = "115",
pages = "147--153",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - The effect of obesity on the ed95 of propofol for loss of consciousness in children and adolescents

AU - Olutoye, Olutoyin A.

AU - Yu, Xiaoying

AU - Govindan, Kalyani

AU - Tjia, Imelda M.

AU - East, Deborah L.

AU - Spearman, Renee

AU - Garcia, Priscilla J.

AU - Coulter-Nava, Crystal

AU - Needham, Jennifer

AU - Abrams, Stephanie

AU - Kozinetz, Claudia A.

AU - Andropoulos, Dean B.

AU - Watcha, Mehernoor F.

PY - 2012/7

Y1 - 2012/7

N2 - INTRODUCTION:: Anesthesiologists face a dilemma in determining appropriate dosing of anesthetic drugs in obese children. In this study we determined the dose of propofol that caused loss of consciousness in 95% (ED95) of obese and nonobese children as determined by loss of eye lash reflex. METHODS:: Forty obese (body mass index [BMI] > 95th percentile for age and gender) and 40 normal weight (BMI 25th to 84th percentile) healthy ASA 1 to 2 children ages 3 to 17 years presenting for surgical procedures were studied using a biased coin design. The primary endpoint was loss of lash reflex at 20 seconds after propofol administration. The first patient in each group received 1.0 mg/kg of IV propofol, and subsequent patients received predetermined propofol doses based on the lash reflex response in the previous patient. If the lash reflex was present, the next patient received a dose increment of 0.25 mg/kg. If the lash reflex was absent, the next patient was randomized to receive either the same dose (95% probability) or a dose decrement of 0.25 mg/kg (5% probability). The ED95 and 95% confidence intervals (CI) were calculated using isotonic regression and bootstrapping methods respectively. RESULTS:: The ED95 of propofol for loss of lash reflex was significantly lower in obese pediatric patients (2.0 mg/kg, approximate 95% CI, 1.8 to 2.2 mg/kg) in comparison with nonobese patients (3.2 mg/kg, approximate 95% CI, 2.7 to 3.2 mg/kg), P ≤ 0.05. DISCUSSION:: A simple approach to deciding what dose of propofol should be used for induction of anesthesia in children ages 3 to 17 years is to first establish the child's BMI on readily available gender-specific charts. Obese children (BMI >95th percentile for age and gender) require a lower weight-based dose of propofol for induction of anesthesia, than do normal-weight children.

AB - INTRODUCTION:: Anesthesiologists face a dilemma in determining appropriate dosing of anesthetic drugs in obese children. In this study we determined the dose of propofol that caused loss of consciousness in 95% (ED95) of obese and nonobese children as determined by loss of eye lash reflex. METHODS:: Forty obese (body mass index [BMI] > 95th percentile for age and gender) and 40 normal weight (BMI 25th to 84th percentile) healthy ASA 1 to 2 children ages 3 to 17 years presenting for surgical procedures were studied using a biased coin design. The primary endpoint was loss of lash reflex at 20 seconds after propofol administration. The first patient in each group received 1.0 mg/kg of IV propofol, and subsequent patients received predetermined propofol doses based on the lash reflex response in the previous patient. If the lash reflex was present, the next patient received a dose increment of 0.25 mg/kg. If the lash reflex was absent, the next patient was randomized to receive either the same dose (95% probability) or a dose decrement of 0.25 mg/kg (5% probability). The ED95 and 95% confidence intervals (CI) were calculated using isotonic regression and bootstrapping methods respectively. RESULTS:: The ED95 of propofol for loss of lash reflex was significantly lower in obese pediatric patients (2.0 mg/kg, approximate 95% CI, 1.8 to 2.2 mg/kg) in comparison with nonobese patients (3.2 mg/kg, approximate 95% CI, 2.7 to 3.2 mg/kg), P ≤ 0.05. DISCUSSION:: A simple approach to deciding what dose of propofol should be used for induction of anesthesia in children ages 3 to 17 years is to first establish the child's BMI on readily available gender-specific charts. Obese children (BMI >95th percentile for age and gender) require a lower weight-based dose of propofol for induction of anesthesia, than do normal-weight children.

UR - http://www.scopus.com/inward/record.url?scp=84863003188&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863003188&partnerID=8YFLogxK

U2 - 10.1213/ANE.0b013e318256858f

DO - 10.1213/ANE.0b013e318256858f

M3 - Article

VL - 115

SP - 147

EP - 153

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 1

ER -