![]() A patient with decreased liver function will not be able to clear certain drugs like narcotics from the body promptly. A patient with decreased lung function/ventilation will not be able to exhale vapor anesthetics promptly. A patient with heart failure or decreased cardiac output will not be able to pump the drug efficiently throughout the body to the lungs, liver, or kidneys to clear the drug. Depending on the medication, one or more of these organ systems are required to clear the drug from the body. ![]() Patients with decreased function of one or more of the major organ systems, that is the heart, lungs, liver, or kidney.What if an anesthesia provider administers his or her standard recipe for anesthesia without noticing that their current patient only weighs 88 pounds? Standard doses for a 150-pound person will be excessive in an 88-pound patient. Markedly increasing the weight of fat cells does not mean the brain needs twice the dose of medications. The second patient will need higher doses than the first, but will not require twice the dose. Imagine two patients who are the same age and height, but one weighs 150 pounds and the second weighs 300 pounds. ![]() Intravenous doses of medications are calculated according to a patient’s weight, but this number should be their lean body weight, not their weight including excess fat. Older persons, especially those over the age of 70-80 years, require lower doses. As you age your ability to metabolize medications decreases. Patients who claim they are “sensitive to all medicines.”.Conversely, patients who have zero or modest exposure to drugs like alcohol can require lower doses of anesthetic drugs. Chronic alcoholism increases the induction dose of propofol in humans. ![]() Chronic alcohol consumption increases the dose of propofol required to induce loss of consciousness (Fassoulaki, A et al. That is, they never or very rarely drink alcohol, and never take sedating medications of any kind.
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