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.