Pharmacodynamics and Pharmacokinetics of Anesthesia in Obese Children: A Systematic Review

Objectives: To investigate the existing literature on the pharmacokinetics (PK) and pharmacodynamic (PD) of anesthetic agents in obese children. Methods: A total of 419 pertinent publications were found after a comprehensive search across four databases. 26 full-text publications were examined after duplicates were eliminated using Rayyan QCRI and relevance was checked; five studies finally satisfied the requirements for inclusion. Results: We included five studies with a total of 10,570 children and less than half of them 4741 (44.8%) were females. Research on the PK of propofol in obese adolescents identified total body weight (TBW) as a key determinant of drug clearance, emphasizing the limitations of relying solely on clinical factors for dosing. Additionally, a study on fentanyl highlighted the importance of TBW for loading doses and LBW/ lean body weight (LBW) for maintenance dosing, while cautioning against the heightened susceptibility of severely obese patients to fentanyl's respiratory side effects, necessitating careful PD considerations. Conclusion: Anesthesia management in obese children requires addressing unique physiological and pharmacological challenges. This review emphasizes the importance of TBW in dosing strategies and the integration of LBW and IBW for maintenance regimens to minimize risks. While offering valuable insights, further research is needed to validate these findings and establish standardized protocols, ultimately enhancing safety and efficacy in anesthetic care for obese pediatric patients.