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Weight-Based and Ideal Body Weight Dosing(IBW)

Why anesthesia doses run on weight, when ideal body weight beats actual weight, and how infusion rates fall out of the math.

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When actual weight is the wrong number

Weight-based dosing has a catch: fat isn't very vascular and doesn't take up most anesthetic drugs the way lean tissue does. For a lot of drugs, dosing a large patient on total body weight overshoots — sometimes badly. That's where ideal body weight comes in: an estimate of lean mass from height and sex (the Devine formula), used in place of the scale number so a tall or heavy patient gets a dose that matches their physiology instead of their bulk.

Infusions add one more step

A bolus stops at the dose. An infusion doesn't — you still have to turn that dose into a pump setting. It's the step that eats time and invites arithmetic errors mid-case: dose (per kilogram, per minute or hour) times weight, divided by the concentration in the bag, to land on mL/hr. The logic is simple; doing it under pressure while everything else is happening is not.

Where Master Anesthesia comes in

Master Anesthesia does this reasoning for you. the In-Post Dose Calculator lives inside every drug page — set the weight, pick adult or peds, and it applies per-kg dosing, swaps in ideal body weight for the drugs that need it, and works out the infusion rate in mL/hr from the concentration. The clinical logic above, done in a tap.

Included in

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Clinical Access Pro unlocks every calculator and clinical reference tool in the app, plus 6 AANA-accredited CE credits. Full Access CE includes all of that and the full course library when you’re ready to earn more.

References

  1. 1. Fat-free mass versus ideal body weight scalar for anesthetic induction dose of propofol in patients with morbid obesity: a double-blind, randomized clinical trial (2023).
  2. 2. Considerations for intravenous anesthesia dose in obese children: understanding pharmacokinetics and pharmacodynamics (2023).
  3. 3. Friesen JH. Normalised lean weight and drug doses for obese patients. Anaesthesia. 2018.
  4. 4. Ingrande J, Lemmens HJM. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105(Suppl 1):i16–i23.
  5. 5. Devine BJ. Ideal body weight estimation (Devine formula). Drug Intell Clin Pharm. 1974.