A retrospective description of anesthetic medication dosing in overweight and obese children

SummaryIntroduction: Pediatric obesity is a major health concern in the United Statesand as many as 34% of those who require general anesthesia are overweightor obese (OW). The lack of data and recommendations for dosing medica-tions in obese children leaves significant gaps in the understanding of correctdosing in the clinical setting.Objective: To determine whether OW children were more likely to receivedoses of medications outside the recommended range.Methods: Following IRB approval, patient medical records were queried toidentify children 2 through 17 years who underwent noncardiac surgeries andreceived at least one medication of interest. Children with hepatic disease,renal disease, neurological impairment, sleep-disordered breathing, or missingheight or weight measurements were excluded. Children were stratified intoweight categories based on age and gender percentiles as per CDC guidelines.Those ≥85th percentile were classified as overweight/obese. Ideal and leanweight (for age, gender) were calculated. Drug doses were stratified as under-dosed (>10% below minimum recommended dose), overdosed (>10% abovemaximum recommended dose), or within recommended dose (dose 10%).Actual doses were compared to recommended doses as per actual, ideal, orlean weight (as recommended for specific drugs) in the overweight/obesegroups vs the control weight (CW) group.Results: Ten thousand five hundred and nine doses were reviewed. Over-weight/obese children were more likely to receive doses outside the recom-mended dose range than the CW group.Conclusions: Overweight/obese children were more likely to receive doses ofcommon anesthetic medications outside the recommended doses potentiallyadding risk of adverse outcomes in these children.IntroductionPediatric obesity is a major public health concern in theUnited States (1), with up to 34% of school-age childrenand adolescents being overweight [body mass index(BMI) ≥85th percentile] or obese (BMI ≥95th percen-tile). Indeed, childhood obesity prevalence has increasedup to threefold over the last three decades (1,2). RecentCenters for Disease Control and Prevention (CDC) data(2010) suggest that a slight decrease in obesity and mor-bid obesity in poor, preschool, nonnative American orAlaskan populations have decreased slightly during theprevious 7 years (3). However, obesity continues to be atroubling attribute of America’s young people. Further-more, more than 30% of pediatric patients presentingfor surgery in one large pediatric setting were foundto be overweight or obese (OW) (4). These trends sug-gest a need to address specific healthcare needs of this