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Anaesthetists' drug dosing practices in class III obese surgical patients: A bi-national survey

Hussain, Z ORCID: 0000-0003-0819-3380, Gadd, R, Curtain, C ORCID: 0000-0001-5029-7541, Mirkazemi, C ORCID: 0000-0002-2345-6313, Peterson, GM ORCID: 0000-0002-6764-3882 and Zaidi, STR ORCID: 0000-0002-2031-1055 2019 , 'Anaesthetists' drug dosing practices in class III obese surgical patients: A bi-national survey' , Anaesthesia and Intensive Care , pp. 1-6 , doi: 10.1177/0310057X19886596.

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Class III obese (body mass index 40 kg/m2) patients, now regularly encountered clinically, have increased perioperativerisks, including potentially from suboptimal drug dosing. However, current dosing guidelines are based on low-levelevidence and may not be widely accepted. This study aimed to investigate anaesthetists’ dosing practices for class IIIobese surgical patients, explore if they had experienced an increased incidence of adverse events potentially related todrug dosing with these patients and assess which resources they consulted for dosing advice in this population.An electronic survey was emailed to 1000 randomly selected members of the Australian and New Zealand Collegeof Anaesthetists. Data were summarised and the Pearson’s χ2 test was used to compare respondents’ genders, geographic locations and seniority designations with the greater Australian and New Zealand College of Anaesthetists’membership. There were 230 completed responses (response rate 23%). A large proportion (46%–76%) of respondentsindicated they dose class III obese patients in keeping with current recommendations; however, substantial heterogeneity in dosing practices was found. Lean body weight was the most frequently used regimen for dosing propofol,non-depolarising muscle relaxants, sugammadex and opioids, whereas total body weight was most frequently used forsuxamethonium. Nearly 70% of respondents reported using at least one resource to assist their dosing practices inobesity. Importantly, increased incidences of adverse events in class III obese patients related to drug dosing werecommonly experienced by respondents. Until higher-level evidence is available for dosing class III obese patients,anaesthetists should consider current recommendations and exercise increased attention to dosing. Further clinicianeducation may assist in optimising dosing in this patient group.

Item Type: Article
Authors/Creators:Hussain, Z and Gadd, R and Curtain, C and Mirkazemi, C and Peterson, GM and Zaidi, STR
Keywords: Anaesthetists, adverse events, class III obesity, drug dosing, dosing resources, survey
Journal or Publication Title: Anaesthesia and Intensive Care
Publisher: Australian Soc Anaesthetists
ISSN: 0310-057X
DOI / ID Number: 10.1177/0310057X19886596
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Copyright The Author(s) 2019

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