Anesthesia of high-risk patients during surgical approach: Strategies adapted for patients with comorbidities

Abstract

Introduction: The anesthetic management of high-risk patients, especially those with significant comorbidities, represents an important clinical challenge. This study reviews the anesthetic strategies adapted for these patients, focusing on interventions that can minimize perioperative complications and improve surgical outcomes. Methods: Studies published between 2010 and 2024 were analyzed, using databases such as PubMed, Scielo, and the Brazilian Journal of Anesthesiology. The review included randomised controlled trials that compared different anaesthetic techniques and their implications for high-risk patients. Studies without a control group were excluded from the analysis. Results: The results indicated that patients at high risk of obstructive sleep apnea have a higher incidence of adverse respiratory events, which highlights the importance of specific anesthetic strategies for this population. Pressure-controlled volume-assured ventilation (PCV-VG) was superior to volume-controlled ventilation (VCV) in obese patients undergoing laparoscopic surgery in the Trendelenburg position, providing better ventilatory parameters and oxygenation. Costoclavicular block has been identified as an effective and safe technique for upper limb anesthesia in obese patients, reducing the need for general anesthesia. In cardiac surgeries, glucose-insulin-potassium (GIK) administration has been shown to be beneficial, reducing adverse cardiac events and improving hemodynamic stability. Finally, spinal anesthesia has been shown to be preferable to general anesthesia in lumbar spine surgeries for high-risk patients, promoting greater intraoperative stability. Conclusion: It is concluded that the personalization of anesthetic strategies is essential to optimize the management of high-risk patients, taking into account individual characteristics and comorbidities. Careful choice of anesthetic techniques can minimize complications, improve postoperative outcomes, and ensure a safer recovery. The integration of new evidence and the adoption of multidisciplinary approaches are essential to improve perioperative care and promote better outcomes in complex and vulnerable patients.