An aid to drug dosing safety in obese children: development of a new nomogram and comparison with existing methods for estimation of ideal body weight and lean body mass |
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| Authors: | L. C. Callaghan J. D. Walker |
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| Affiliation: | 1. Department of Anaesthesia, Alder Hey Children's Hospital, Liverpool, UK;2. Department of Anaesthesia, Ysbyty Gwynedd, Bangor, UK |
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| Abstract: | The risk of accidental over‐dosing of obese children poses challenges to anaesthetists during dose calculations for drugs with serious side‐effects, such as analgesics. For many drugs, dosing scalars such as ideal body weight and lean body mass are recommended instead of total body weight during weight‐based dose calculations. However, the complex current methods of obtaining these dosing scalars are impractical in the peri‐operative setting. Arbitrary dose adjustments and guesswork are, unfortunately, tempting solutions for the time‐pressured anaesthetist. The study's aim was to develop and validate an accurate, convenient alternative. A nomogram was created and its performance compared with the standard calculation method by volunteers using measurements from 108 obese children. The nomogram was as accurate (bias 0.12 kg vs ?0.41 kg, respectively, p = 0.4), faster (mean (SD) time taken 2.8 (1.0) min (vs 3.3 (0.9) min respectively, p = 0.003) and less likely to result in mistakes (significant errors 3% vs 19%, respectively, p = 0.001). We present a system that simplifies estimation of ideal body weight and lean body mass in obese children, providing foundations for safer drug dose calculation. |
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