ANESTHESIA IN THE OBESE PATIENT: PHYSIOPATHOLOGICAL PECULIARITIES, PERIOPERATIVE RISKS, AND SAFETY STRATEGIES

Abstract

Introduction: Obesity is a chronic clinical condition associated with metabolic, cardiovascular, respiratory, and pharmacokinetic alterations that significantly modify the body's response to anesthetic procedures. Reduced respiratory reserve, an increased likelihood of airway management difficulties, the presence of comorbidities, and changes in the distribution and elimination of drugs make the perioperative care of these patients particularly challenging. Objective: To analyze the key pathophysiological features related to anesthesia in obese patients, discuss associated perioperative risks, and present evidence-based strategies to enhance anesthetic safety. Methodology: A narrative literature review was conducted, drawing on scientific publications in the fields of anesthesiology, respiratory physiology, clinical pharmacology, and perioperative safety, as well as recommendations from specialized medical societies. Relevant scientific reviews and clinical guidelines were considered, with a focus on literature available up to October 2026. Discussion: The primary anesthetic considerations in obesity include a reduction in functional residual capacity, increased oxygen consumption, a higher predisposition to atelectasis, potential difficulties with ventilation and intubation, a high prevalence of obstructive sleep apnea, and alterations in the pharmacokinetics and pharmacodynamics of anesthetic agents. These factors can contribute to hypoxemia, hypoventilation, hemodynamic instability, pulmonary aspiration, residual neuromuscular blockade, and thromboembolic complications. Individualized pre-anesthetic assessment, proper patient positioning, pre-oxygenation, protective ventilation strategies, careful selection of medications, and postoperative monitoring are essential components in the prevention of adverse events. Conclusion: Anesthesia for obese patients requires individualized planning, an understanding of the underlying pathophysiological changes, and the systematic implementation of safety measures. Obesity, in isolation, does not determine the occurrence of complications, nor does it constitute an automatic contraindication to anesthesia or surgery. Identifying risk factors, optimizing clinical status, and ensuring the availability of appropriate resources are essential for improving perioperative outcomes.