Fentanyl Metabolism in Obese Adolescents
Condition: Morbid Obesity
MeSH terms: Obesity, Morbid
Study type: Observational

Summary: 
      Fentanyl is a frequently used pain medication in pediatric and adult anesthesia. Although
      there are some studies considering the breakdown of oral, transmucosal and intravenous
      fentanyl preparations in children, the disposition of fentanyl in pediatric patients has not
      been sufficiently described. This study aims to show that the clearance of fentanyl in obese
      children and adolescents is increased as compared to children with a normal weight.
      Consequently, the elimination half-life of fentanyl is different in overweight and obese
      children from that in children having a normal body weight.
    

Detailed description: 
      Obesity represents one of the most important public health issues according to the World
      Health Organization. It has reached epidemic proportions globally, with approximately 1.5
      billion overweight adults 20 years and older and at least 600 million of them clinically
      obese in 2008. According to the most recent NHANES survey (2003-2006), over two-third of the
      adults in the US are overweight or obese (overweight 68%, half of them obese) and about 17.6%
      of children and adolescents aged 12 to 19 were considered overweight or obese.

      Obesity has also become an important challenge for the anesthesiologist. Safety and drug
      dosing particularly within the field of pediatric anesthesia, is of paramount concern as it
      can affect patient outcomes. Data collected in the United Kingdom from more than 100,000
      anesthetized pediatric patients showed that a critical incident is twice as likely to occur
      in an obese child in the preoperative period as in an obese adult. A possible explanation may
      be linked to the lack of precision in drug dosing for these obese patients.

      Fentanyl is a frequently used opioid analgesic in pediatric and adult anesthesia. Fentanyl is
      commonly administered to pediatric patients undergoing anesthesia as it is has a high
      potency, a rapid onset and a short duration of action. Due to these properties intravenously
      administered fentanyl is well suited as an analgesic compound in general anesthesia in
      pediatric patients.

      The pharmacokinetics of fentanyl in adults have been well documented. Although there are some
      studies investigating the pharmacokinetic properties of oral, transmucosal and intravenous
      fentanyl preparations in children, the disposition of fentanyl in pediatric patients has not
      been sufficiently described. Several studies in infants and children report age-dependent
      differences in the pharmacokinetic/ pharmacodynamic parameters of intravenously administered
      fentanyl.

      Currently there are no data available about the pharmacokinetics/ pharmacodynamics of
      fentanyl in adolescent obese patients.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Single, hospital based surgical center
      
Biospecimen description: 
      whole blood
    
Keywords: Obesity, adolescence,pharmacokinetics,fentanyl