Adjusting propofol dosage to 2 mg/kgBW in overweight children resulted in comparable rates of preincision hypotension and hormonal regulation compared to normal-weight children receiving 3.2 mg/kgBW.
Observational (n=59)
Does adjusting propofol dosage in overweight children avoid hypotension and affect hormonal regulation compared to regular weight children under general anesthesia?
Adjusting propofol dosage in overweight children reduces preincision hypotension to levels seen in normal-weight patients without altering hormonal counter-regulation.
Obesity in pediatric surgical patients is a challenge for the anesthesiologist. Despite potentially beneficial properties, propofol might also induce hypotension. This study examined whether a dose adjustment in overweight children could avoid hypotension and if there would be differences regarding hormonal regulation in children under anesthesia. Fifty-nine children undergoing surgery under general anesthesia were enrolled in this prospective observational trial. Participants were allocated into two groups according to their BMI. The induction of anesthesia was conducted using propofol ("overweight": 2 mg/kgBW, "regular": 3.2 mg/kgBW). The maintenance of anesthesia was conducted as total intravenous anesthesia. Hormone levels of renin, angiotensin II, aldosterone, copeptin, norepinephrine and epinephrine were assessed at different timepoints. Blood pressure dropped after the administration of propofol in both groups, with a nadir 2 min after administration-but without a significant difference in the strength of reduction between the two groups. As a reaction, an increase in the plasma levels of renin, angiotensin and aldosterone was observed, while levels of epinephrine, norepinephrine and copeptin dropped. By adjusting the propofol dosage in overweight children, the rate of preincision hypotension could be reduced to the level of normal-weight patients with a non-modified propofol dose. The hormonal counter regulation was comparable in both groups. The release of catecholamines and copeptin as an indicator of arginine vasopressin seemed to be inhibited by propofol.
Hempel et al. (Mon,) conducted a observational in Pediatric surgical patients (n=59). Propofol dose adjustment based on BMI vs. Normal-weight children receiving 3.2 mg/kgBW was evaluated on Preincision hypotension and hormonal regulation. Adjusting propofol dosage to 2 mg/kgBW in overweight children resulted in comparable rates of preincision hypotension and hormonal regulation compared to normal-weight children receiving 3.2 mg/kgBW.