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August 31, 2026Eskisehir Medical Journal Eskisehir City Hospital

Perioperative Anesthetic Management of Adults With Obesity: A Practical Narrative Review

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Key result

Perioperative anesthesia in obesity should use ideal body weight tidal volumes and PEEP to limit atelectasis.

Why the study?

Obesity affects over 890 million adults worldwide, and altered cardiorespiratory physiology complicates perioperative anesthetic care across surgical procedures.

Population

Adults with obesity

Design

Practical narrative review

Authors

AAAli Rıza AtaAnadolu University

Discussion

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Implication

May inform individualized perioperative care in obesity; leaves open need for prospective outcome trials.

Key Points

  • To provide a comprehensive, evidence-based review of perioperative anesthetic management strategies across all surgical phases in adult patients with obesity.
  • Searched PubMed, Cochrane Library, and Embase databases for literature on obesity, anesthesia, airway management, lung-protective ventilation, and regional anesthesia.
  • Synthesized findings from clinical practice guidelines, randomized controlled trials, meta-analyses, and comprehensive reviews under thematic perioperative phases.
  • Preoperative management requires STOP-BANG screening and individualized fasting plans accounting for glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy, while airway safety improves with ramped positioning and routine video laryngoscopy.
  • Mechanical ventilation requires tidal volumes calculated from ideal body weight; evidence from the PROBESE trial demonstrates that high positive end-expiratory pressure (PEEP) does not reduce postoperative pulmonary complications, though 8–12 cmH₂O PEEP pragmatically reduces intraoperative hypoxemia and atelectasis.
  • Medication dosing requires individualized scaling using total, lean, or adjusted body weight, while regional techniques such as external oblique intercostal plane blocks decrease postoperative opioid consumption.

Structured PICO

P
Population
Adults with obesity (BMI ≥40 kg/m², or BMI ≥35 kg/m² with serious obesity-related comorbidities)
I
Intervention
Perioperative anesthetic management (including preoperative assessment, airway management, lung-protective ventilation, regional anesthesia, and drug dosing)

This narrative review provides an evidence-based overview of perioperative anesthetic management for adults with obesity, emphasizing individualized preoperative assessment, optimized airway management, and appropriate drug dosing.

Cite This Study

Ali Rıza Ata (2026) conducted a review in Obesity. Perioperative anesthetic management was evaluated. Perioperative anesthetic management of adults with obesity should incorporate individualized assessment, ideal body weight-based tidal volume, and 8-12 cmH2O PEEP to limit postoperative atelectasis.

synapsesocial.com/papers/6a953aec6af7ed2fcaea0c71https://doi.org/10.48176/esmj.2026.282
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The obese patient undergoing nonbariatric surgery2016 · 35 citations
  2. 2Anesthesiological perspective on the obese patients: challenges and management - literature review2025
  3. 3Perioperative care of the obese patient2020 · 83 citations
  4. 4Metabolic syndrome: anesthesia for morbid obesity2010 · 50 citations
  5. 5Perioperative Management of Morbidly Obese Patients: Clinical Advances2025