(1031) Impact of Body Weight on Safety and Efficacy of Propofol

Introduction: Propofol, a 10% oil-in-water emulsion, is a commonly used sedative in the intensive care unit (ICU). Potential pharmacokinetic changes in obese patients may increase the risk of oversedation and adverse effects. The purpose of this study was to determine if there are differences in safety and efficacy associated with propofol use across a range of body weight and body mass index (BMI).

Methods: This was a single-center, retrospective cohort study at a tertiary academic medical center. Patients admitted to an ICU and initiated on a propofol infusion with at least one triglyceride level (TGL) were included. Patients with a TGL >400 mg/dL prior to propofol initiation were excluded. The major outcome was incidence of hypertriglyceridemia (HTG) defined as TGL >500 mg/dL. Minor outcomes included incidence of propofol-induced pancreatitis, hyperlipasemia (lipase >60 U/L), hypotension (systolic blood pressure < 90 mm Hg), bradycardia (heart rate < 50 beats per minute), and sedation depth (median daily Richmond Agitation-Sedation Scale (RASS)). Body weight was analyzed as a continuous variable with additional analyses performed with pre-defined BMI categories: < 30 kg/m2 (non-obese) and ≥30 kg/m2 (obese). Statistical analysis included chi-squared for discrete variables and t-test or ANCOVA for continuous variables. Univariable and multivariable logistic regressions were performed on the major outcome.

Results: Of the 639 patients screened for inclusion, 150 were included in the final analysis with 94 (62.7%) and 56 (37.3%) in the non-obese and obese groups, respectively. HTG occurred in 11 (11.7%) non-obese and 8 (14.3%) obese patients (p=0.65). Younger age was the only risk factor for HTG identified in both univariable and multivariable analysis. There were no differences between groups in other safety outcomes. Overall, there was no difference in sedation depth (median RASS score -3 in obese and non-obese groups; p=0.46). Both groups experienced deeper sedation on varying days throughout the study.

Conclusions: This study did not find an association between body weight or BMI and the incidence of HTG. No differences were seen in other safety and efficacy outcomes. Additional larger-scale studies should be conducted to further assess the potential risk of adverse effects and differences in efficacy.