• Vidya Chidambaran, Anurag Tewari, and Mohamed Mahmoud.
• Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: vidya.chidambaran@cchmc.org.
• J Clin Anesth. 2018 Mar 1; 45: 39-50.

PurposeAnesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children.SourceMEDLINE and PubMed peer-reviewed manuscripts in obesity and pediatric anesthesia. When there was no information in pediatric literature, we included adult studies in our review.Principal FindingsDefining obesity in a growing child is based on body mass index percentiles specific to age and sex. The precursors of adult obesity-related comorbidities are often seen in obese children. Respiratory and cardiovascular comorbidities increase perioperative risk in the severely obese child [>99th percentile]. Obstructive sleep apnea is highly prevalent and requires consideration of opioid sparing techniques and careful postoperative disposition. A detailed discussion on the effect of obesity on pharmacokinetics of different commonly used anesthetics and analgesics is presented, with current recommendations on dosing.ConclusionOptimal and safe anesthetic management of an obese child requires thoughtful pre-procedure assessment and meticulous perioperative management tailored to associated comorbidities, with heightened awareness of potential perioperative complications. There remains a need for improved guidelines for risk stratification, drug dosing and postoperative disposition in this patient population.Copyright © 2017 Elsevier Inc. All rights reserved.

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