Evaluation of Propofol Dosing Based on Total Body Weight Using Closes-loop Anaesthesia Delivery System
Status:
Not yet recruiting
Trial end date:
2024-08-10
Target enrollment:
Participant gender:
Summary
The pharmacokinetic profile of various drugs is altered in obese patients especially those
administered by the intravenous route. Propofol is the commonly used intravenous anesthetic
agent for induction and maintenance of anaesthesia as part of total intravenous anaesthesia
(TIVA) regimen. A major concern with propofol dosing based on total body weight (TBW) in
obese patients is disproportionate drug administration leading to undue drug accumulation in
body with a potential to overdosing, delayed recovery from anaesthesia, and adverse
hemodynamic outcome. Studies on propofol dosing based on various weight scalars have
recommended that lean body weight (LBW) should be used for calculating bolus dose during
anaesthesia induction and TBW or adjusted body weight (ABW) for arriving at an infusion dose
required for maintenance of anaesthesia. Although propofol delivery based on dose calculated
by TBW has been well researched the evidence for propofol delivery based on dose calculated
by ABW is lacking.
Recent advance in the delivery of propofol has been the development of computer controlled
anaesthesia delivery systems. These devices deliver propofol based on patient's frontal
cortex electrical activity as determined by bispectral index (BIS). Evaluation of anaesthesia
delivery by these systems has shown that they deliver propofol and maintain depth of
anaesthesia with far more precision as compared to manual administration. One such
indigenously developed computer controlled anaesthesia delivery system is the closed loop
anaesthesia delivery system (CLADS). CLADS functions on control of processed EEG response
parameter captured from anaesthetized patients with the help of a BIS- monitor, which is
continuously fed into an automated drug infusion pump. The infusion pump then accordingly
delivers the anaesthetic drug to the patients based on pharmacodynamic requirements. We plan
to evaluate the propofol maintenance dose requirement based on TBW versus ABW using CLADS for
propofol delivery.