Anesthesia in Obese Patients: Clinical Challenges, Perioperative Risks, and Evidence-Based Strategies for Safe Management
Submission: 07 August 2025 | Acceptance: 02 September 2025 | Publication: 01 October 2025
1Kamran Safdar, 2Hamza Raja, 3Dr. Attique Afzal Malik, 4Murad Javed, 5Hadi Raza
1UHS Lahore
2PIMS Islamabad
3Assistant professor, Anaesthesia, SMDAS. DHQ Teaching Hospital Haripur.
4Mayo Hospital Lahore
5Sir Gangaram Lahore
Abstract
Background: Obesity is a growing global health problem that significantly increases perioperative risk during anesthesia. It is associated with anatomical, physiological, and metabolic changes that complicate airway management, ventilation, and drug pharmacokinetics.
Objective: This review aims to analyze the major challenges of administering anesthesia in obese patients and to highlight effective evidence-based strategies for improving perioperative safety and outcomes.
Methods: A narrative review approach was used, focusing on published literature related to obesity and anesthesia, including airway management, respiratory physiology, pharmacology, and perioperative care strategies. Relevant clinical studies, guidelines, and reviews were analyzed.
Results: Obese patients demonstrate increased difficulty in airway management, reduced functional residual capacity, and higher risk of hypoxemia and aspiration. Cardiovascular strain and altered drug distribution further complicate anesthetic care. Evidence supports the use of ramped positioning, video laryngoscopy, individualized drug dosing based on lean body weight, and lung-protective ventilation strategies. Preoperative optimization and postoperative respiratory support significantly reduce complications.
Conclusion: Anesthesia in obese patients presents significant challenges; however, with careful preoperative assessment, advanced airway techniques, and individualized perioperative strategies, patient safety and outcomes can be substantially improved. A structured, multidisciplinary approach is essential for optimal management of this high-risk population.
Keywords: Safe Management, Anesthesia, Obese Patients, Clinical Challenges, Perioperative Risks, and Evidence-Based Strategies.