Propofol Sedation for Intragastric Balloon Removal: Looking for the Optimal Body Weight Descriptor

  • Georgia TsaousiEmail author
  • Barbara Fyntanidou
  • George Stavrou
  • Pyrros Papakostas
  • Katerina Kotzampassi
  • Vasilios Grosomanidis
Original Contributions



Sedation is considered as a prerequisite for the safe and effective conclusion of Bioenterics Intragastric Balloon (BIB) removal (our aim was to ascertain the most appropriate body size scalars for propofol dosing and assess the efficacy and safety of a sedative approach involving the infusion of propofol for BIB removal.


Retrospective analysis of prospectively collected data of 414 adults scheduled to undergo BIB removal. Our primary end-point was to delineate the relationship between propofol dosing and body size descriptors namely body mass index, total body weight, ideal body weight, lean body weight (LBW) and normalized LBW. Sedative efficacy of this practice, anesthesia or procedural-related adverse events and patients’ satisfaction level served as secondary outcome parameters.


Propofol dose (mg/kg/min) was positively related to all body weight descriptors in an important manner (p < 0.001). Among them, LBW was singled out as the body size descriptor to best capture the appropriate needs of propofol (R2 = 0.432; p = 0.000). Hypoxemia, hemodynamic compromise, gastroesophageal reflux or moderate movement occurred rarely; all of them were readily reversed. The majority of participants had no recollection of the noxious phase of the procedure or declared at least adequately satisfied from the experience (84% and 95%, respectively).


LBW could serve as relatively more accurate dosing scalar compared to actual or ideal body weight descriptors, in obese individuals undergoing BIB removal under propofol sedation. The conscious/deep sedation based on propofol infusion emerges as a feasible and efficacious sedative approach for this procedure.


Obesity Intragastric balloon Propofol Body weight scalar 



No funding was received for this study; no corporate sponsor was involved.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

• All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

• For this type of study, formal consent is not required.


  1. 1.
    De Baerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesthesiol. 2016;29:119–28.CrossRefGoogle Scholar
  2. 2.
    Neto MG, Silva LB, Grecco E, et al. Brazilian Intragastric balloon consensus statement (BIBC): practical guidelines based on experience of over 40,000 cases. Surg Obes Relat Dis. 2018;14(2):151–9.CrossRefGoogle Scholar
  3. 3.
    Messina T, Genco A, Favaro R, et al. Intragastric balloon positioning and removal: sedation or general anesthesia? Surg Endosc. 2011;25(12):3811–4.CrossRefGoogle Scholar
  4. 4.
    Kotzampassi K, Grosomanidis V, Papakostas P, et al. 500 intragastric balloons: what happens 5 years thereafter? Obes Surg. 2012;22:896–903.CrossRefGoogle Scholar
  5. 5.
    Kotzampassi K, Shrewsbury AD, Papakostas P, et al. Looking into the profile of those who succeed in losing weight with an intragastric balloon. J Laparoendosc Adv Surg Tech A. 2014;24:295–301.CrossRefGoogle Scholar
  6. 6.
    Sudré ECM, de Batista PR, Castiglia YMM. Longer immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort study. Obes Surg. 2015;25:2205–12.CrossRefGoogle Scholar
  7. 7.
    Cortínez LI, Anderson BJ. Advances in pharmacokinetic modeling: target controlled infusions in the obese. Curr Opin Anaesthesiol. 2018;31:415–22.CrossRefGoogle Scholar
  8. 8.
    Cortinez LI, Anderson BJ, Penna A, et al. Influence of obesity on propofol pharmacokinetics: derivation of a pharmacokinetic model. Br J Anaesth. 2010;105:448–56.CrossRefGoogle Scholar
  9. 9.
    Green B, Duffull SB. What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol. 2004;58:119–33.CrossRefGoogle Scholar
  10. 10.
    Horgan GW, Stubbs J. Predicting basal metabolic rate in the obese is difficult. Eur J Clin Nutr. 2003;57:335–40.CrossRefGoogle Scholar
  11. 11.
    Wong C, Marwick TH. Obesity cardiomyopathy: pathogenesis and pathophysiology. Nat Clin Pract Cardiovasc Med. 2007;4:436–43.CrossRefGoogle Scholar
  12. 12.
    Subramani Y, Riad W, Chung F, et al. Optimal propofol induction dose in morbidly obese patients: a randomized controlled trial comparing the bispectral index and lean body weight scalar. Can J Anaesth. 2017;64:471–9.CrossRefGoogle Scholar
  13. 13.
    Janmahasatian S, Duffull SB, Ash S, et al. Quantification of lean bodyweight. Clin Pharmacokinet. 2005;44:1051–65.CrossRefGoogle Scholar
  14. 14.
    Lemmens HJ, Brodsky JB, Bernstein DP. Estimating ideal body weight: a new formula. Obes Surg. 2005;15:1082–3.CrossRefGoogle Scholar
  15. 15.
    Callaghan LC, Walker JD, Williams DJ. Nomograms for calculating drug doses in obese adults. Anaesthesia. 2016;71:977–8.CrossRefGoogle Scholar
  16. 16.
    Hicks C, Trickett A, Kwan YL, et al. The use of adjusted ideal body weight for overweight patients undergoing HPC mobilisation for autologous transplantation. Ann Hematol. 2012;91:1795–801.CrossRefGoogle Scholar
  17. 17.
    Shin S, Park CH, Kim HJ, et al. Patient satisfaction after endoscopic submucosal dissection under propofol-based sedation: a small premedication makes all the difference. Surg Endosc. 2017;31(6):2636–44.CrossRefGoogle Scholar
  18. 18.
    de Graaff JC, Bijker JB, Kappen TH, et al. Incidence of intraoperative hypoxemia in children in relation to age. Anesth Analg. 2013;117:169–75.CrossRefGoogle Scholar
  19. 19.
    Liu Y, Pian-Smith MC, Leffert LR, et al. Continuous measurement of cardiac output with the electrical velocimetry method in patients under spinal anesthesia for cesarean delivery. J Clin Monit Comput. 2015;29:627–34.CrossRefGoogle Scholar
  20. 20.
    Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth. 1970;42:535–42.CrossRefGoogle Scholar
  21. 21.
    Likert R. A technique for the measurement of attitudes. Arch Psychol. 1932;22:1–55.Google Scholar
  22. 22.
    Pandit JJ, Cook TM, Jonker WR, et al. A national survey of anaesthetists (NAP5 baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in the UK. Anaesthesia. 2013;68:343–53.CrossRefGoogle Scholar
  23. 23.
    Riphaus A, Wehrmann T, Weber B, et al. S3 guideline: sedation for gastrointestinal endoscopy 2008. Endoscopy. 2009;41:787–815.CrossRefGoogle Scholar
  24. 24.
    Ingrande J, Brodsky JB, Lemmens HJ. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011;113:57–62.CrossRefGoogle Scholar
  25. 25.
    Sasaki T, Tanabe S, Azuma M, et al. Propofol sedation with bispectral index monitoring is useful for endoscopic submucosal dissection: a randomized prospective phase II clinical trial. Endoscopy. 2012;44:584–9.CrossRefGoogle Scholar
  26. 26.
    Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105(Suppl 1):i16–23.CrossRefGoogle Scholar
  27. 27.
    Dong D, Peng X, Liu J, et al. Morbid obesity alters both pharmacokinetics and pharmacodynamics of propofol: dosing recommendation for anesthesia induction. Drug Metab Dispos. 2016;44:1579–83.CrossRefGoogle Scholar
  28. 28.
    Martin JH, Saleem M, Looke D. Therapeutic drug monitoring to adjust dosing in morbid obesity - a new use for an old methodology. Br J Clin Pharmacol. 2012;73(5):685–90.CrossRefGoogle Scholar
  29. 29.
    Diepstraten J, Chidambaran V, Sadhasivam S. Blussé van oud-Alblas HJ, Inge T, et al. an integrated population pharmacokinetic meta-analysis of propofol in morbidly obese and nonobese adults, adolescents, and children. CPT Pharmacometrics Syst Pharmacol. 2013;2:e73.CrossRefGoogle Scholar
  30. 30.
    Leykin Y, Miotto L, Pellis T. Pharmacokinetic considerations in the obese. Best Pract Res Clin Anaesthesiol. 2011;25:27–36.CrossRefGoogle Scholar
  31. 31.
    Friesen JH. Estimating the induction dose of propofol in morbid obesity: striking a happy medium. Br J Anaesth. 2016;116(5):730–1.CrossRefGoogle Scholar
  32. 32.
    Eleveld DJ, Proost JH, Cortinez LI, et al. A general purpose pharmacokinetic model for propofol. Anesth Analg. 2014;118:1221–37.CrossRefGoogle Scholar
  33. 33.
    Eleveld DJ, Proost JH, Vereecke H, et al. An allometric model of remifentanil pharmacokinetics and pharmacodynamics. Anesthesiology. 2017;126:1005–18.CrossRefGoogle Scholar
  34. 34.
    Badaoui R, Cabaret A, Alami Y, et al. Reversal of neuromuscular blockade by sugammadex in laparoscopic bariatric surgery: in support of dose reduction. Anaesth Crit Care Pain Med. 2016;35:25–9.CrossRefGoogle Scholar
  35. 35.
    Lemmens HJ. Perioperative pharmacology in morbid obesity. Curr Opin Anaesthesiol. 2010;23:485–91.CrossRefGoogle Scholar
  36. 36.
    Scherrer PD, Mallory MM, Cravero JP, et al. The impact of obesity on pediatric procedural sedation-related outcomes: results from the pediatric sedation research consortium. Paediatr Anaesth. 2015;25:689–97.CrossRefGoogle Scholar
  37. 37.
    Meyhoff CS, Henneberg SW, Jorgensen BG, et al. Depth of anaesthesia monitoring in obese patients: a randomized study of propofol-remifentanil. Acta Anaesthesiol Scand. 2009;53:369–75.CrossRefGoogle Scholar
  38. 38.
    Han PY, Duffull SB, Kirkpatrick CM, et al. Dosing in obesity: a simple solution to a big problem. Clin Pharmacol Ther. 2007;82:505–8.CrossRefGoogle Scholar
  39. 39.
    Liu FL, Cherng YG, Chen SY, et al. Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2015;62:907–17.CrossRefGoogle Scholar
  40. 40.
    Leslie K, Clavisi O, Hargrove J. Target-controlled infusion versus manually-controlled infusion of propofol for general anaesthesia or sedation in adults. Cochrane Database Syst Rev. 2008;3:CD006059.Google Scholar
  41. 41.
    Laosuwan S, Pongruekdee S, Thaharavanich R. Comparison of effective-site target controlled infusion and manually controlled infusion of propofol for sedation during spinal anesthesia. J Med Assoc Thail. 2011;94:965–71.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and ICU, Faculty of MedicineAristotle University of ThessalonikiThessalonikiGreece
  2. 2.Department of General Surgery, York Teaching HospitalNHS Foundation TrustYorkUK
  3. 3.Department of Surgery, Faculty of MedicineAristotle University of ThessalonikiThessalonikiGreece

Personalised recommendations