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As the population of morbidly obese patients increases worldwide, anaesthesiologists are increasingly confronted with the dilemma of finding appropriate drug dosing regimens for these difficult-to-manage patients. The altered physiological changes that accompany obesity include increases in blood volume, body water, muscle mass and cardiac output; factors that inter-alia affect volumes of distribution and total body clearance [2, 3]. Although dose regimens based on lean body mass (LBM) or ideal body weight (IBW) may result in inadequate anaesthesia, concern arises that dosing according to total body weight (TBW) may give rise to adverse haemodynamic effects. Unfortunately, there is a paucity of scientific studies that addresses these issues, and therefore many practitioners compromise by estimating a dosing weight that is between IBW and TBW [4].

Commercially available devices, approved for delivery of …