title: Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study.
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.
  
  
  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.
  
  
  BACKGROUND
  NCT01955993 (clinicaltrials.gov).
authors.affiliation: Division of Anesthesiology, Sedation and Perioperative Medicine, Children's National Health System, Washington, DC, USA.
authors.forename: Janelle D
authors.initials: JD
authors.lastname: Vaughns
authors.affiliation: Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC, USA. Ziesenitz.md@gmail.com.|Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany. Ziesenitz.md@gmail.com.|Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, 4056, Basel, Switzerland. Ziesenitz.md@gmail.com.
authors.forename: Victoria C
authors.identifier: http://orcid.org/0000-0003-2836-4212
authors.initials: VC
authors.lastname: Ziesenitz
authors.affiliation: Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC, USA.
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Williams
authors.affiliation: Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC, USA.
authors.forename: Alvina
authors.initials: A
authors.lastname: Mushtaq
authors.affiliation: Institute of Legal and Traffic Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Bachmann
authors.affiliation: Institute of Legal and Traffic Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Skopp
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Weiss
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Mikus
authors.affiliation: Division of Pediatric Clinical Pharmacology, Children's National Health System, Washington, DC, USA.|Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.|Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, 4056, Basel, Switzerland.
authors.forename: Johannes N
authors.initials: JN
authors.lastname: van den Anker
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000493:pharmacokinetics; D050110:Bariatric Surgery; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D005283:Fentanyl