Authors: Sawires J et al.
Cureus, June 9, 2026.
Summary
This systematic review evaluated how obesity affects propofol dosing, anesthetic effectiveness, hemodynamic stability, respiratory safety, recovery, and pharmacokinetics and pharmacodynamics.
The authors reviewed 16 studies involving adults with obesity who received propofol for procedural sedation or general anesthesia. The included literature consisted of randomized trials, observational studies, and pharmacokinetic and pharmacodynamic modeling studies.
The major concern was whether dosing propofol according to total body weight is appropriate in patients with obesity.
Obesity alters body composition, cardiac output, regional blood flow, volume of distribution, clearance, and the relationship between propofol concentration and clinical effect. These changes make simple total-body-weight dosing unreliable.
Across the reviewed studies, propofol dosing based on total body weight was frequently associated with greater cardiovascular depression, including hypotension and bradycardia. Higher doses did not consistently improve the adequacy of hypnosis or sedation.
The evidence suggested that patients with obesity may require a lower dose relative to total body weight for induction than non-obese patients. Lean body weight, individualized titration, target-controlled infusion, and model-informed dosing may provide safer starting points.
Respiratory and airway complications were also more common as body mass index increased. Reported events included:
• Hypoxemia
• Apnea
• Airway obstruction
• Need for airway repositioning or additional airway maneuvers
• Increased requirement for respiratory intervention during procedural sedation
These risks are partly related to obesity-associated reductions in functional residual capacity, greater airway collapsibility, obstructive sleep apnea, and reduced respiratory reserve. Excessive propofol dosing may worsen these underlying vulnerabilities.
Recovery ou