General Anaesthesia in Athletes: Physiological Adaptations, Pharmacological Nuances, and Clinical Management

Abstract

Background. Years of high-intensity training induce profound cardiovascular, autonomic and body-composition adaptations that may influence the response to general anaesthesia. The trained athlete therefore represents a distinct perioperative population.

Aim. To appraise and synthesise evidence on the perioperative care of athletes undergoing general anaesthesia, focusing on cardiovascular and autonomic adaptation, body composition and drug disposition, preoperative and airway assessment, induction and maintenance, anaesthetic technique, performance-enhancing drugs, and anti-doping regulations.

Material and methods. A narrative review of the scientific literature was conducted, drawing on anaesthesiology, cardiology and sports medicine sources.

Results. Endurance training produces eccentric cardiac hypertrophy with balanced four-chamber dilation and increased resting vagal tone, whereas resistance training promotes a concentric pattern. Pronounced vagal predominance may contribute to clinically significant perioperative bradyarrhythmias in highly trained endurance athletes, as described in case reports. Lean body weight may be considered when dosing hypnotic induction agents in highly muscular patients, although supporting evidence derives mainly from obese populations and remains unvalidated in athletes. Greater muscular strength has been associated with higher Modified Mallampati scores. Undisclosed performance-enhancing drug use may increase perioperative risk through coronary disease, myocardial fibrosis and hypercoagulability. The World Anti-Doping Agency Code also creates specific considerations for prescribing anaesthesiologists.

Conclusions. General anaesthesia in athletes requires an individualised, evidence-informed approach. Recognition of physiological adaptations, thorough cardiovascular and airway assessment, cautious drug dosing and preparedness for unexpected bradyarrhythmia are essential.