Obesity-related anesthesia risk represents a significant and growing challenge in perioperative medicine due to the rising prevalence of obesity worldwide. Patients with obesity present unique anatomical and physiological considerations that increase the complexity of anesthesia management and elevate the risk of perioperative complications. These risks affect airway management, respiratory function, cardiovascular stability, medication dosing, and postoperative recovery, requiring careful planning and specialized anesthetic care.

One of the most critical concerns in obese patients is airway management. Excess soft tissue in the neck and upper airway increases the risk of difficult mask ventilation and intubation. Limited neck mobility, reduced mouth opening, and obstructive sleep apnea are commonly associated conditions that further complicate airway control. During anesthesia induction, obese patients desaturate more rapidly due to reduced functional residual capacity, leaving little margin for error if airway access is delayed.

Respiratory function is significantly affected by obesity. Reduced lung volumes, impaired chest wall compliance, and increased oxygen consumption contribute to a higher risk of hypoventilation, hypoxia, and postoperative respiratory complications. Positioning during surgery must be carefully optimized to improve ventilation and reduce pressure on the diaphragm, while ventilation strategies are adjusted to maintain adequate oxygenation without causing lung injury.

Cardiovascular risk is also elevated in obese patients due to increased cardiac workload, hypertension, coronary artery disease, and cardiomyopathy. Anesthetic drugs can cause exaggerated hemodynamic responses, and fluid management requires precise control to avoid both overload and hypovolemia. Continuous monitoring of blood pressure, oxygenation, and cardiac function is essential throughout the perioperative period.

Medication dosing in obesity presents additional challenges, as altered body composition affects drug distribution, metabolism, and clearance. Anesthesiologists carefully calculate dosages based on ideal, lean, or adjusted body weight depending on the pharmacological properties of each agent to ensure efficacy while minimizing adverse effects.

Postoperative care is particularly important in obese patients, who are at increased risk of airway obstruction, respiratory depression, thromboembolic events, wound complications, and delayed recovery. Pain management strategies emphasize multimodal analgesia to reduce opioid requirements and minimize respiratory compromise. Early mobilization and vigilant monitoring in the recovery area or high-dependency unit help prevent complications.

Obesity-related anesthesia risk does not preclude safe surgery when managed appropriately. Through thorough pre-anesthesia assessment, tailored anesthetic techniques, advanced airway planning, and structured postoperative care, anesthesiology teams play a vital role in ensuring safe and effective outcomes for obese patients undergoing surgical and diagnostic procedures