Authors: Lehmeidi Y, Beck Neto T
Cureus 17(8): e90661, August 2025. doi:10.7759/cureus.90661
This comprehensive review explored the potential impact of creatine supplementation on anesthetic outcomes. Creatine, widely used for its role in ATP buffering and energy metabolism, may theoretically influence anesthetic pharmacodynamics by supporting mitochondrial stability, modulating calcium handling, and reducing oxidative stress. The review synthesized findings from 25 studies, mostly preclinical, involving agents such as sevoflurane, propofol, and ketamine.
Animal studies suggest creatine preloading can alter anesthetic responses, including changes in bispectral index (BIS) values, induction and emergence times, and postoperative recovery. However, human evidence is largely absent, and routine preoperative evaluations rarely consider creatine use despite its widespread supplementation among athletes and the elderly. Clinical implications may include altered anesthetic requirements, improved perioperative neuroprotection, and protection against postoperative muscle wasting, especially in high-risk or aging populations.
The authors emphasize the urgent need for randomized controlled trials to assess anesthetic dosing, BIS/MAC responses, and recovery profiles in creatine-supplemented patients, while also suggesting perioperative screening for creatine use.
What you should know:
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Creatine supplementation enhances ATP buffering and mitochondrial protection, potentially influencing anesthetic pharmacodynamics.
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Preclinical studies suggest altered anesthetic induction, emergence, and depth with creatine, but human data are lacking.
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Creatine may protect against oxidative stress, hypoxia, and muscle loss in perioperative settings.
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Routine anesthesia practice does not account for creatine use, though supplementation is common in athletes and elderly patients.
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Future clinical trials are essential to clarify whether creatine meaningfully affects anesthetic requirements and outcomes.
Thank you to Cureus for publishing this timely review on the intersection of creatine supplementation and anesthetic management.