Perioperative care in children with obesity. A narrative review

• Childhood obesity has tripled in the last 30 years, it is a public health concern. • Surgical procedures in children living with obesity have increased by 25%. • Individualized risk assessment and comorbidities are essential before surgery. • Drug dosing must be tailored to obesity-related pharmacokinetic changes. • Severe obesity has a higher complication rate, demanding multidisciplinary team. Childhood obesity is a complex chronic disease characterized by the pathological accumulation of adipose tissue, which has direct and deleterious effects on the structure and function of multiple organs and systems. Its increasingly high global prevalence has become a major public health concern particularly in regions such as Latin America and the Caribbean. This problem has also been associated with an increasing number of children requiring surgical procedures, posing new challenges to perioperative care. A thorough preoperative evaluation and an individualized management plan are essential to minimize risks and complications in this vulnerable population, with particular attention on the identification and assessment of comorbidities. This narrative review summarizes current evidence on the perioperative management of children with overweight and obesity, addressing diagnostic assessment, preoperative preparation, intraoperative and postoperative care, and drug dosing adjustments based on obesity-related pharmacokinetic alterations. Emphasis is placed on a comprehensive, multidisciplinary approach to ensure safe and effective surgical outcomes.