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Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study

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An Erratum to this article was published on 16 March 2017

Abstract

Background

The number of obese pediatric patients requiring anesthesia is rapidly increasing. Although fentanyl is a commonly used narcotic during surgery, there are no pharmacokinetic (PK) data available for optimal dosing of fentanyl in adolescents with clinically severe obesity.

Materials and Methods

An institutional review board-approved exploratory pilot study was conducted in six adolescents aged 14–19 years undergoing bariatric surgery. Mean total body weight (TBW) and mean BMI were 137.4 ± 14.3 kg and 49.6 ± 6.4 kg/m2 (99.5th BMI percentile), respectively. Fentanyl was administered intravenously for intraoperative analgesia based on ideal body weight per standard of care. PK blood samples were drawn over a 24-h post-dose period. Fentanyl PK parameters were calculated by non-compartmental analysis.

Results

Mean fentanyl AUC0–∞ was 1.5 ± 0.5 h·ng/mL. Systemic clearance of fentanyl was 1522 ± 310 mL/min and 11.2 ± 2.6 mL/min·kg TBW. Volume of distribution was 635 ± 282 L and 4.7 ± 2.1 L/kg TBW. While absolute clearance was increased, absolute volume of distribution was comparable to previously established adult values.

Conclusions

These results suggest that fentanyl clearance is enhanced in adolescents with clinically severe obesity while volume of distribution is comparable to previously published studies.

Study registration

NCT01955993 (clinicaltrials.gov).

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Acknowledgements

This project was supported by Award Number UL1RR031988 from the NIH National Center for Research Resources.

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Author notes

    Authors and Affiliations

    1. Division of Anesthesiology, Sedation and Perioperative Medicine, Children’s National Health System, Washington, DC, USA

      Janelle D. Vaughns

    2. Division of Pediatric Clinical Pharmacology, Children’s National Health System, Washington, DC, USA

      Victoria C. Ziesenitz, Elaine F. Williams, Alvina Mushtaq & Johannes N. van den Anker

    3. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany

      Victoria C. Ziesenitz, Johanna Weiss & Gerd Mikus

    4. Institute of Legal and Traffic Medicine, University of Heidelberg, Heidelberg, Germany

      Ricarda Bachmann & Gisela Skopp

    5. Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands

      Johannes N. van den Anker

    6. Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, 4056, Basel, Switzerland

      Victoria C. Ziesenitz & Johannes N. van den Anker

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    1. Janelle D. Vaughns
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    Corresponding author

    Correspondence to Victoria C. Ziesenitz.

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    Conflicts of interest

    This project was supported by Award Number UL1RR031988 from the NIH National Center for Research Resources.

    All authors (JDV, VCZ, EFW, AM, RB, GS, JW, GM, JNvdA) declare that they have no conflict of interest.

    Research involving human participants and/or animals

    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.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    J. D. Vaughns and V. C. Ziesenitz contributed equally

    An erratum to this article is available at http://dx.doi.org/10.1007/s40272-017-0220-x.

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    Vaughns, J.D., Ziesenitz, V.C., Williams, E.F. et al. Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study. Pediatr Drugs 19, 251–257 (2017). https://doi.org/10.1007/s40272-017-0216-6

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    • DOI: https://doi.org/10.1007/s40272-017-0216-6

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