Safety of Target-Controlled Infusion in Patients with Obesity: A Narrative Review

Background/Objectives: Obesity alters propofol pharmacokinetics, creating bidirectional safety concerns during Target-Controlled Infusion (TCI). The 5th National Audit Project reported that patients with obesity were over-represented among cases of accidental awareness, and that awareness was more frequent when neuromuscular blockade was used.

Methods

We examined the literature on the mechanisms and clinical evidence underlying relative overdosing, underdosing, awareness, and postoperative respiratory risk in patients with obesity receiving propofol anesthesia.