Drug | Weight for dosing | Notes |
Sedative/hypnotics | ||
Propofol bolus doses | AdjBW | |
Propofol maintenance infusions | AdjBW | Titrate to clinical endpoint. |
Etomidate | AdjBW | |
Ketamine | AdjBW | |
Thiopental | AdjBW | Doses should be adjusted for high or low cardiac output, and rapid redistribution may result in more rapid awakening after a single bolus dose than in lean patients. |
Midazolam (and other benzodiazepines) bolus doses | TBW | For sedation, usually dosed in small increments (eg, midazolam 1 mg IV) titrated to effect. Caution should be exercised as patients with OSA may have increased central sensitivity to the sedative and respiratory effects of benzodiazepines. TBW is used for induction of anesthesia, due to high lipophilicity and thus increased volume of distribution in obese patients. |
Midazolam (and other benzodiazepines) continuous infusions | AdjBW | Titrate to effect. |
Dexmedetomidine | TBW | Titrate to effect. Dose adjustments may be required for comorbidities or other sedative or anesthetic drugs used concomitantly. |
Opioids | ||
Synthetic opioids (fentanyl, sufentanil, alfentanil, and remifentanil) | TBW | When possible, titrate to effect. |
Morphine | IBW | Initial dosing should be based on IBW and further administration titrated to effect. |
Hydromorphone | IBW | As with morphine, initial dosing is based on IBW and then further titrated to effect. |
Lidocaine, systemic | ||
Bolus | AdjBW | |
Infusion | AdjBW | |
Neuromuscular blocking agents | ||
Nondepolarizing agents (eg, vecuronium, rocuronium) | IBW versus TBW | The dosing scalar will depend on the clinical circumstance. In general, a higher (ie, closer to TBW) intubating dose will result in faster onset and shorter time to complete NMB, but a longer duration of action. An IBW-based dosing will prolong the time to ideal intubating conditions, but assure a faster recovery from NMB. |
Succinylcholine | TBW | |
Reversal agents | ||
Sugammadex | AdjBW | |
Neostigmine | AdjBW |
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