Anesthesia in Patients with Sarcopenic Obesity
DOI:
https://doi.org/10.5281/zenodo.21852862Keywords:
Sarcopenic Obesity, Anesthesia, Perioperative Care, Airway Management, Postoperative ComplicationsAbstract
Sarcopenic obesity is a clinical condition characterized by the coexistence of excessive adipose tissue and reduced skeletal muscle mass and function, and it is associated with an increased risk of clinical and surgical complications. In anesthetic practice, this condition has emerged as a growing challenge due to physiological alterations that affect preoperative assessment, airway management, anesthetic pharmacokinetics and pharmacodynamics, as well as postoperative recovery. This study aimed to review the scientific evidence regarding the main anesthetic challenges associated with sarcopenic obesity and discuss strategies to optimize perioperative safety. A narrative literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Embase, SciELO, and the Virtual Health Library, including studies published between 2016 and 2026. The available evidence indicates that patients with sarcopenic obesity are more likely to experience respiratory, cardiovascular, and metabolic complications, delayed functional recovery, and increased perioperative morbidity and mortality. Assessment of body composition, individualized anesthetic monitoring, appropriate pharmacological dose adjustment, and multidisciplinary perioperative protocols were identified as essential strategies for improving clinical outcomes. In conclusion, early recognition of sarcopenic obesity and individualized anesthetic management are crucial for minimizing perioperative complications and enhancing patient safety. Further high-quality studies are needed to strengthen current evidence and support future clinical guidelines.
References
1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.
2. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31-81.
3. Ingrande J, Lemmens HJM. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105(Suppl 1):i16-i23.
4. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018;14(9):513-537.
5. Kalinkovich A, Livshits G. Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev. 2017;35:200-221.
6. Nightingale CE, Margarson MP, Shearer E, Redman JW, Lucas DN, Cousins JM, et al. Peri-operative management of the obese surgical patient 2021: guidelines from the Association of Anaesthetists. Anaesthesia. 2021;76(11):1475-1490.
7. Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9.
8. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31-81.
9. Ingrande J, Lemmens HJM. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105(Suppl 1):i16-i23.
10. Leykin Y, Brodsky JB, Lemmens HJM. Pharmacokinetic and pharmacodynamic considerations in the obese patient undergoing anesthesia. Best Pract Res Clin Anaesthesiol. 2011;25(1):27-36.
11. Naguib M, Brull SJ, Kopman AF, Hunter JM, Fülesdi B, Arkes HR, et al. Consensus Statement on Perioperative Use of Neuromuscular Monitoring. Anesth Analg. 2018;127(1):71-80.
12. Brull SJ, Kopman AF. Current Status of Neuromuscular Reversal and Monitoring: Challenges and Opportunities. Anesthesiology. 2017;126(1):173-190.
13. Chan MTV, Hedrick TL, Egan TD, García PS, Koch S, Purdon PL, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes. Anesth Analg. 2020;130(5):1278-1291.
14. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery—2018. Br J Anaesth. 2018;121(5):1005-1012.
15. Saugel B, Kouz K, Meidert AS, Schulte-Uentrop L, Romagnoli S. How to measure blood pressure using an arterial catheter: a systematic 5-step approach. Crit Care. 2020;24:172.
16. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018;14(9):513-537.
17. Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care. Anesthesiol Clin. 2015;33(1):17-33.
18. Ljungqvist O, de Boer HD, Balfour A, Fawcett WJ, Lobo DN, Nelson G, et al. Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery: A Review. JAMA Surg. 2021;156(8):775-784.
19. Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, et al. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Clin Nutr. 2022;41(4):990-1000.
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Copyright (c) 2026 Eduardo Rocha Hoyer
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