Table 1.

Considerations for anesthetic agents in pediatric patients with obesity.

Agent	Implication
Propofol	Obese children require lower weight-based dose of propofol for induction of anesthesia compared to normal-weight children (2 mg/kg vs. 3.2 mg/kg) [40].
Inhalational agents	Clinically insignificant difference with Isoflurane, Sevoflurane shows a faster recovery [41].
Succinylcholine	TBW (total body weight) should be used for dosing [41].
Non-depolarizing muscle relaxants	Vecuronium shows prolonged effect, may be due to TBW dosing. Rocuronium shows slight prolongation [41]. Ideal body weight (IBW) should be considered for dosing [39].
Opioids	Clearance of fentanyl is significantly increased, lower plasma concentration during early phase. Sufentanil clearance is similar [41]. Morphine, in contrast, is hydrophilic and should be dosed by TBW [39].
Benzodiazepines	Midazolam shows lower concentrations with obese patients and increased duration of action [42].
Dexmedetomidine	May decrease opioid requirements. No studies of dexmedetomidine pharmacology in pediatric obesity [41].
Ketamine	May decrease opioid requirements. Lipophilic but limited pharmacokinetic studies in obesity [39].
Acetaminophen	IBW should be used for dosing [43].