Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea.
Korean J Anesthesiol. 2021 Dec;74(6):478-487. doi: 10.4097/kja.21345. Epub 2021 Aug 18.
The prevalence of obesity is increasing, resulting in an increase in the number of surgeries performed to treat obesity and diseases induced by obesity. The associated comorbidities as well as the pharmacokinetic and pharmacodynamic changes that occur in obese patients make it difficult to control the appropriate dose of anesthetic agents. Factors that affect pharmacokinetic changes include the increase in adipose tissue, lean body weight, extracellular fluid, and cardiac output associated with obesity. These physiological and body compositional changes cause changes in the pharmacokinetic and pharmacodynamic parameters. The increased central volume of distribution and alterations in the clearance of drugs affect the plasma concentration of propofol and remifentanil in the obese population. Additionally, obesity can affect pharmacodynamic properties, such as the 50% of maximal effective concentration and the effect-site equilibration rate constant (ke0). Conducting a simulation of target-controlled infusions based on pharmacokinetic and pharmacodynamic models that include patients that are obese can help clinicians better understand the pharmacokinetic and pharmacodynamic changes of anesthetic drugs associated with this population.
肥胖的流行率正在上升，导致治疗肥胖症和肥胖引起的疾病的手术数量增加。肥胖患者出现的相关合并症以及药代动力学和药效动力学变化使得难以控制麻醉剂的适当剂量。影响药代动力学变化的因素包括与肥胖相关的脂肪组织、瘦体重、细胞外液和心输出量的增加。这些生理和身体成分的变化导致药代动力学和药效动力学参数的变化。中央容积分布的增加以及药物清除率的改变会影响肥胖人群中丙泊酚和瑞芬太尼的血浆浓度。此外，肥胖会影响药效学特性，如最大有效浓度的 50%和效应部位平衡速率常数 (ke0)。基于包括肥胖患者在内的药代动力学和药效动力学模型进行靶控输注模拟可以帮助临床医生更好地理解与该人群相关的麻醉药物的药代动力学和药效动力学变化。
