Journal of the Korea Convergence Society (한국융합학회논문지)

Korea Convergence Society (한국융합학회)
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Adequate anesthetic induction dose in a morbidly obese patient based on bioelectrical impedance analysis. -Case report-

병적 비만 환자에서 생체 전기 임피던스 분석을 이용한 적절한 마취 유도 용량 -증례보고-

  • Lee, Ki-Jae (Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital) ;
  • Choi, Seungseo (Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital) ;
  • Baek, Seon Ju (Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital) ;
  • Kim, Dong-Chan (Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital) ;
  • Lee, Jeongwoo (Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital) ;
  • Lee, Jun Ho (Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital)
  • 이기재 (전북대학교병원 마취통증의학과) ;
  • 최승서 (전북대학교병원 마취통증의학과) ;
  • 백선주 (전북대학교병원 마취통증의학과) ;
  • 김동찬 (전북대학교병원 마취통증의학과) ;
  • 이정우 (전북대학교병원 마취통증의학과) ;
  • 이준호 (전북대학교병원 마취통증의학과)
  • Received : 2020.09.02
  • Accepted : 2020.10.20
  • Published : 2020.10.28
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Abstract

Background: The dosage of the anesthetic drugs is generally determined by the total body weight of the patients. However, the drugs can be overdosed when the patient is morbidly obese. We have determined anesthetic induction dose based on lean body mass estimated from bioelectrical impedance analysis (BIA). Case: We report a case of morbidly obese patient (161 cm, 138 kg and body mass index 53.1) who had an elective laparoscopic cholecystectomy. The dose of induction agent was determined by lean body mass estimated by BIA, and the sedation was assessed by the observer's assessment alertness/sedation scale. Conclusions: Dose determination through lean body mass measured by BIA is useful in highly obese patients.

배경: 마취약제의 용량은 일반적으로 환자의 총체중량으로 결정된다. 그러나 병적 비만 환자에서 그 용량은 과량투여 되기 쉽다. 약물의 적절한 용량을 결정하는 기준은 다소 모호하지만, 마취 유도시 생체 전기 임피던스 분석(BIA)을 통해 마른체중을 구하여 마취 유도용량을 결정할 수 있다. BIA를 통해 총체내수분을 구하고, 체내수분을 제외한 체중을 쉽게 계산할 수 있다. 증례: 복강경 담낭절제술이 예정된 병적 비만 환자(161 cm, 138 kg and 체질량지수 53.1)의 증례를 보고하고자 한다. BIA로 예측한 마른체중을 통해 마취 유도제의 용량을 결정하고, 각성/진정척도를 통해 진정 상태를 평가하였다. 결론: BIA로 측정한 마른체중을 통해 약물 용량을 결정하는 것은 병적 비만 환자에서 유용하다.

Keywords

References

  1. S. Lotia & M. C. Bellamy. (2008). Anaesthesia and morbid obesity. Continuing Education in Anaesthesia Critical Care & Pain, 8, 151-6. https://doi.org/10.1093/bjaceaccp/mkn030
  2. O. Visnjevac, S. Davari-Farid, J. Lee, L. Pourafkari, P. Arora, H. H. Dosluoglu. (2015). The effect of adding functional classification to ASA status for predicting 30-day mortality. Anesth Analg 121, 110-6. https://doi.org/10.1213/ANE.0000000000000740
  3. D. L. Prior, J. Sprung, J. D. Thomas, D. G. Whalley, D. L. Bourke. (2003). Echocardiographic and hemodynamic evaluation of cardiovascular performance during laparoscopy of morbidly obese patients. Obes Surg, Oct;13(5), 761-7. https://doi.org/10.1381/096089203322509354
  4. D. J. Morgan & K. M. Bray. (1994). Lean body mass as a predictor of drug dosage. Implications for drug therapy. Clin Pharmacokinet 26, 292-307. https://doi.org/10.2165/00003088-199426040-00005
  5. K. R. Segal, M. Van Loan, P. I. Fitzgerald, J. A. Hodgdon & T. B. Van Itallie. (1988). Lean body mass estimation by bioelectrical impedance analysis: a four-site cross-validation study. Am J Clin Nutr, 47, 7-14. https://doi.org/10.1093/ajcn/47.1.7
  6. U. G. Kyle, I. Bosaeus, A. D. De Lorenzo, P. Deurenberg, M. Elia & J. M. Gomez. (2004). Bioelectrical impedance analysis-part I: review of principles and methods. Clinical Nutrition, 23, 1226-43. https://doi.org/10.1016/j.clnu.2004.06.004
  7. Research DMGoO. Research on obesity : a report of the DHSS/MRC group/compiled by W. P. T. James. (1976). Department of Health and Social Security [and the] Medical Research Council. London, H.M.S.O.
  8. P. Boer. (1984). Estimated lean body mass as an index for normalization of body fluid volumes in humans. Am J Physiol, 247, F632-6.
  9. R. Hume. (1966). Prediction of lean body mass from height and weight. J Clin Pathol, 19, 389-91. https://doi.org/10.1136/jcp.19.4.389
  10. A. Pandazi, A. Bourlioti & G. Kostopanagiotou. (2005). Bispectral Index (BIS) monitoring in morbidly obese patients undergoing gastric bypass surgery: experience in 23 patients. Obes Surg, Jan;15(1), 58-62. https://doi.org/10.1381/0960892052993585
  11. D. A. Chernik, D. Gillings, H. Laine, J. Hendler, J. M. Silver & A. B. Davidson. (1990) Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol, 10, 244-51.
  12. Z. Wu, J. Li, C. Wang, J. Yang, X. Chen & W. Yang. (2018). Characterization of cardiovascular depression effect for propofol during anesthesia induction period on morbidly obese patients. Biomed Pharmacother, 106, 618-23. https://doi.org/10.1016/j.biopha.2018.06.158
  13. D. Chassard, K. Berrada, B. Bryssine, M. Guiraud, P. Bouletreau. (1996). Influence of body compartments on propofol induction dose in female patients. Acta Anaesthesiol Scand, Sep;40(8 Pt 1), 889-91. https://doi.org/10.1111/j.1399-6576.1996.tb04555.x
  14. R. B. Mazess, H. S. Barden, J. P. Bisek, & J. Hanson. (1990). Dual-energy x-ray absorptiometry for total-body and regional bone-mineral and soft-tissue composition. Am J Clin Nutr, 51, 1106-12. https://doi.org/10.1093/ajcn/51.6.1106
  15. S. Janmahasatian, S. B. Duffull, S. Ash, L. C Ward, N. M. Byrne & B. Green. (2005). Quantification of lean bodyweight. Clin Pharmacokinet, 44, 1051-65. https://doi.org/10.2165/00003088-200544100-00004