Scaling propofol doses for the obese: Is lean body weight the answer?

Longer awakening times have been observed in obese compared to normal-weight patients when propofol is dosed on total body weight (TBW), as per label recommendations. This could be explained by a non-linear relationship between TBW and clearance (CL) as previously demonstrated [1]. Lean body weight (LBW) has been shown to increase non-linearly with TBW and linearly with drug clearance [2]. This body size metric may therefore be more appropriate than TBW for propofol dose selection. The objectives of this study were to evaluate the substitution of a non-linear covariate model for propofol clearance [1] with a linear LBW covariate model and examine the effects of different propofol dosing regimens on awakening times of obese patients