Burke Constance N, Voepel-Lewis Terri, Wagner Deborah, Lau Irwin, Baldock Andrew, Malviya Shobha, Nafiu Olubukola
Department of Pediatric Anesthesiology, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Paediatr Anaesth. 2014 Aug;24(8):857-62. doi: 10.1111/pan.12396. Epub 2014 Apr 8.
Pediatric obesity is a major health concern in the United States and as many as 34% of those who require general anesthesia are overweight or obese (OW). The lack of data and recommendations for dosing medications in obese children leaves significant gaps in the understanding of correct dosing in the clinical setting.
To determine whether OW children were more likely to receive doses of medications outside the recommended range.
Following IRB approval, patient medical records were queried to identify children 2 through 17 years who underwent noncardiac surgeries and received at least one medication of interest. Children with hepatic disease, renal disease, neurological impairment, sleep-disordered breathing, or missing height or weight measurements were excluded. Children were stratified into weight categories based on age and gender percentiles as per CDC guidelines. Those ≥85th percentile were classified as overweight/obese. Ideal and lean weight (for age, gender) were calculated. Drug doses were stratified as under-dosed (>10% below minimum recommended dose), overdosed (>10% above maximum recommended dose), or within recommended dose (dose ± 10%). Actual doses were compared to recommended doses as per actual, ideal, or lean weight (as recommended for specific drugs) in the overweight/obese groups vs the control weight (CW) group.
Ten thousand five hundred and nine doses were reviewed. Overweight/obese children were more likely to receive doses outside the recommended dose range than the CW group.
Overweight/obese children were more likely to receive doses of common anesthetic medications outside the recommended doses potentially adding risk of adverse outcomes in these children.
儿童肥胖是美国主要的健康问题，在需要全身麻醉的儿童中，多达34%超重或肥胖（OW）。缺乏针对肥胖儿童用药剂量的数据和建议，使得在临床环境中对正确剂量的理解存在重大差距。
确定超重/肥胖儿童是否更有可能接受超出推荐范围的药物剂量。
经机构审查委员会（IRB）批准后，查询患者病历以识别2至17岁接受非心脏手术并至少接受一种感兴趣药物的儿童。排除患有肝病、肾病、神经功能障碍、睡眠呼吸紊乱或身高或体重测量缺失的儿童。根据美国疾病控制与预防中心（CDC）指南，根据年龄和性别百分位数将儿童分为不同体重类别。那些≥第85百分位数的儿童被归类为超重/肥胖。计算理想体重和瘦体重（根据年龄、性别）。药物剂量分为剂量不足（低于最低推荐剂量10%以上）、剂量过量（高于最高推荐剂量10%以上）或在推荐剂量范围内（剂量±10%）。将超重/肥胖组与正常体重（CW）组中实际剂量与根据实际、理想或瘦体重（特定药物推荐的）推荐剂量进行比较。
共审查了10509剂药物。超重/肥胖儿童比CW组更有可能接受超出推荐剂量范围的药物剂量。
超重/肥胖儿童更有可能接受超出推荐剂量的常见麻醉药物剂量，这可能会增加这些儿童出现不良后果的风险。
