Anestesia em pacientes com obesidade: evolução das evidências científicas e desafios na prática clínica

Abstract

Obesity increases the number of patients presenting for surgery with physiological changes that challenge anesthetic practice, including reduced respiratory reserve, risk of difficult airway, obstructive sleep apnea and gastric emptying that may be altered by weight-loss drugs. This narrative literature review aimed to describe how the scientific evidence on anesthesia in patients with obesity has evolved and to discuss the challenges for clinical practice. The search was carried out in Europe PMC, which indexes MEDLINE/PubMed, and in general Google searches, for publications from 2018 to 2025; direct access to LILACS, SciELO and Google Scholar was not available. Twenty-three publications were included, analyzed from their abstracts and organized into themes: airway, intraoperative ventilation, obstructive sleep apnea, analgesia and opioid reduction, and GLP-1 receptor agonists. The studies indicate that the emphasis has shifted from identifying the difficult airway to lung protection, respiratory risk stratification, opioid-sparing strategies and, more recently, the assessment of aspiration risk. The retrieved literature is heterogeneous, with many observational studies and case reports, and gaps remain regarding drug dosing, neuromuscular blockade and postoperative recovery. It is concluded that anesthetic care of patients with obesity requires an individualized approach, and that further clinical trials and systematic reviews are needed.