Consideraciones farmacológicas en la anestesia del paciente pediátrico obeso

Pediatric obesity is a prevalent problem in Chile. The pathophysiological changes associated with obesity affect pharmacological parameters, which induce potential dosing errors, especially during pediatric anesthesia. Dosing based on total body weight would be inadequate in this population, so diverse metrics, such as ideal body weight or lean body weight, among others, have been proposed to improve dosing accuracy. However, there is no single metric applicable to all anesthetics. The choice of an appropriate size descriptor depends on the drug, dosing type (bolus or maintenance), and available pharmacokinetic information. The use of pharmacokinetic/pharmacodynamic models, incorporated into infusion pumps, and effect monitoring are essential for individualizing dosing. This article reviews the relevance and definition of pediatric obesity, its pathophysiological consequences, and pharmacological considerations for safer anesthetic dosing.