Ali Rıza ATA
Eskisehir Medical Journal - 2026;7(3):317-325
Introduction: Obesity is an ongoing public health threat with an increasing incidence, affecting more than 890 million adults worldwide, and anesthesiologists encounter these patients daily in nearly all surgical procedures. In morbid obesity (body mass index (BMI) >=40 kg/m², or BMI >=35 kg/m² with serious obesity-related comorbidities), altered respiratory and cardiovascular physiology, along with accompanying obstructive sleep apnea (OSA) and obesity hypoventilation syndrome, further complicate the clinical situation. This review aims to provide a current, evidence-based overview of perioperative anesthetic management of obese patients. Methods: PubMed, Cochrane Library, and Embase databases were searched using keywords including obesity, anesthesia, perioperative management, airway management, lung-protective ventilation, regional anesthesia, and drug dosing in obesity. Current guidelines, randomized controlled trials, meta-analyses, and comprehensive reviews were included. Evidence was synthesized under thematic headings according to perioperative phases. Results: Preoperative assessment should not be limited to BMI alone; ASA classification, STOP-BANG screening, and individualized fasting planning-taking glucagon-like peptide-1 receptor agonist (GLP-1 RA) use into account-should be incorporated. The ramped position and routine video laryngoscopy significantly improve the success and safety of airway management. Tidal volume should be calculated according to ideal body weight. The PROBESE trial showed that high positive end-expiratory pressure (PEEP) does not reduce postoperative pulmonary complications. Nonetheless, 8-12 cmH?O PEEP may be a pragmatic approach to limit intraoperative hypoxemia and postoperative atelectasis. Drug dosing requires an appropriate scaling system (total, lean, or adjusted body weight) for each agent. Newer regional techniques such as the external oblique intercostal plane block reduce opioid consumption in bariatric surgery. Conclusion: Anesthetic management of the obese patient is no longer a rare occurrence but a routine part of clinical practice. Coordinated, evidence-based, multidisciplinary care forms the basis of safe anesthesia in this sensitive and growing patient group.
