Sedation for Obese Patients

Abstract

Obesity has become a global health concern, with an increasing number of obese patients requiring procedural sedation in operating rooms, endoscopy suites, interventional radiology units, and ambulatory surgical centers. Sedation in obese individuals presents unique challenges due to altered respiratory physiology, difficult airway management, pharmacokinetic and pharmacodynamic changes, and a high prevalence of obesity-related comorbidities such as obstructive sleep apnea, obesity hypoventilation syndrome, cardiovascular disease, and diabetes mellitus. Sedation-related adverse events, particularly hypoxemia, airway obstruction, hypercapnia, and cardiovascular instability, occur more frequently in obese patients than in normal-weight individuals. Contemporary advances including capnography, high-flow nasal oxygen, continuous positive airway pressure, and dexmedetomidine-based sedation techniques have improved safety in high-risk populations. Appropriate preprocedural assessment, careful drug selection, optimized dosing strategies, vigilant monitoring, and advanced airway management techniques are essential to improve patient safety. This review summarizes the pathophysiological changes associated with obesity, discusses sedation-related risks, evaluates commonly used sedative agents, and provides evidence-based recommendations for peri-procedural management of obese patients undergoing sedation.