黑料网

Morbid obesity; Drug pharmacokinetics; Pharmacodynamic alterations; Dosing strategies

Introduction

Morbid obesity presents unique challenges in perioperative management, necessitating careful consideration of pharmacological interventions to ensure safe and effective patient care. As the prevalence of obesity continues to rise globally, healthcare providers are increasingly confronted with the complexities of managing surgical patients with obesity-related comorbidities. This article explores the intricacies of perioperative pharmacology in morbid obesity, addressing key considerations, challenges, and strategies for optimizing patient outcomes [1,2].

Understanding morbid obesity and its implications

Morbid obesity, defined as a body mass index (BMI) ≥40 kg/m² or BMI ≥35 kg/m² with obesity-related comorbidities, is associated with a myriad of physiological changes that can impact drug pharmacokinetics and pharmacodynamics [3]. Alterations in body composition, including increased adipose tissue and altered distribution of lean body mass, can affect drug volume of distribution, clearance, and bioavailability. Additionally, obesity-related conditions such as obstructive sleep apnea, insulin resistance, and cardiovascular disease further complicate perioperative management and drug selection [4,5].

Pharmacokinetic considerations

In patients with morbid obesity, alterations in drug pharmacokinetics may necessitate adjustments in dosing regimens to achieve therapeutic efficacy while minimizing the risk of adverse reactions. For lipophilic drugs that distribute extensively into adipose tissue, loading doses based on total body weight may lead to overdosing, necessitating dose adjustments based on ideal body weight or lean body mass. Conversely, hydrophilic drugs may exhibit altered distribution and clearance in obese individuals, requiring dose adjustments based on pharmacokinetic parameters [6,7].

Pharmacodynamic considerations

Obesity-related changes in physiology, such as insulin resistance, altered cardiac function, and changes in drug receptor expression, can influence drug responses and efficacy. For example, obese patients may require higher doses of opioids for adequate pain control due to increased opioid tolerance and altered pharmacokinetics. Similarly, altered sensitivity to neuromuscular blocking agents and anesthetic agents may necessitate adjustments in dosing and monitoring during anesthesia induction and maintenance [8].

Drug Selection and safety considerations

In the perioperative setting, careful consideration should be given to drug selection based on the patient's comorbidities, drug pharmacokinetics, and potential drug interactions. Drugs with extensive hepatic metabolism or renal clearance may require dose adjustments or alternative agents in patients with obesity-related liver or kidney dysfunction. Furthermore, awareness of potential drug interactions with anesthetic agents and other perioperative medications is essential to prevent adverse outcomes [9].

Strategies for Optimization

Optimizing perioperative pharmacology in morbid obesity requires a multidisciplinary approach involving anesthesia providers, surgeons, pharmacists, and other healthcare professionals. Preoperative assessment should include a comprehensive evaluation of the patient's medical history, comorbidities, and medication regimen to guide drug selection and dosing. Tailoring anesthesia techniques, such as regional anesthesia and opioid-sparing strategies, can help minimize perioperative complications and enhance recovery in patients with morbid obesity [10].

Conclusion

Perioperative pharmacology in morbid obesity presents unique challenges that require careful consideration of pharmacokinetic and pharmacodynamic principles to ensure safe and effective patient care. By understanding the physiological changes associated with obesity and individualizing drug therapy based on patient characteristics, healthcare providers can optimize perioperative outcomes and enhance patient safety in this high-risk population. Embracing a multidisciplinary approach and staying abreast of evolving evidence-based practices will be crucial in navigating sperioperative pharmacology in morbid obesity and improving patient outcomes.

1. Alberti TB, Barbosa WL, Vieira JL, Raposo NR, Dutra RC (2017). . Int J Mol Sci. 18: 691.

, ,

2. Anthony M, Romero K, Malone DC, Hines LE, Higgins L, et al. (2009).. Clin Pharmacol Ther. 86: 425-429.

, ,

3. Babatope T, Chotalia J, Elkhatib R, Mohite S, Shah J, et al. (2016). . Psychiatry J. 87: 729-737.

, ,

4. Boswell Smith V, Spina D, Page CP (2006). . Brit J Pharmacol. 1: S252-S257.

, ,

5. Carbone K, Gervasi F (2022). . Plants. 1: 3434.

, ,

6. Czigle S, Tóth J (2011). .
7. Franco L, Sánchez C, Bravo R, Rodríguez AB, Barriga C, et al. (2012). . PLOS ONE. 7:e37290.

, ,

8. Härtter S, Korhonen T, Lundgren S, Rane A, Tolonen A, (2006). . Basic Clin Pharmacol Toxicol. 99: 300-304.

, ,

9. Hwang HS, Baldo MP, Rodriguez JP, Faggioni M, Knollmann BC (2019). . Front Physiol. 10: 992.

, ,

10. James JS (2000). St. John’s wort warning: do not combine with protease inhibitors, NNRTIs. AIDS Treatment News 3-5.

, ,