Analgesics & Sedatives in the Critically Ill Obese Patient
Analgesic and sedative medications are frequently administered to critically ill patients.
Weight-based dosing regimens for these medications can lead to significant over-, or under-, dosing in the critically ill obese patient (BMI > 40 kg/m2).
In order to avoid harm, it is important to know when to use actual body weight (ABW), ideal body weight (IBW), or adjusted body weight in weight-based dosing regimens.
Recommendations for weight-based dosing regimens for commonly used analgesic and sedative medications include:
Opioids: use IBW or adjusted body weight
Ketamine: use IBW or adjusted body weight
Propofol: use IBW or adjusted body weight
Etomidate: use adjusted body weight or ABW
Midazolam: use IBW or adjusted body weight
References
Erstad BL, Barletta JF. Drug dosing in the critically ill obese patient - a focus on sedation, analgesia, and delirium. Crit Care. 2020; 24:315.
