Bidirectional Relationship Between Anaesthetic Drugs and Metabolic Syndrome: Clinical Effects and Mechanisms

Metabolic syndrome (MS) is a multifaceted condition characterised by insulin resistance, dyslipidemia, central obesity and hypertension, significantly elevating the risks of cardiovascular diseases and type 2 diabetes. This review aims to elucidate the bidirectional interplay between anaesthetic agents and MS, highlighting the mutual influence on metabolic regulation and anaesthetic efficacy. Accumulating evidence underscores the disruptive impact of anaesthetic agents on metabolic pathways. General anaesthetics can impair insulin signalling, thereby influencing insulin sensitivity, while local anaesthetics may indirectly affect systemic metabolism via alterations in local metabolic processes and blood flow. For instance, lidocaine interferes with the overall metabolism in the body by inhibiting tissue perfusion and local metabolic processes such as insulin signalling pathways. Conversely, MS can modulate the metabolism and efficacy of anaesthetic drugs, further complicating their clinical application. This review systematically explores the intricate relationship between anaesthetic agents and MS. It begins by delineating the primary features of MS and its potential impact on anaesthetic pharmacology. Subsequently, it examines the effects of diverse anaesthetic agents on components of MS, including insulin resistance, lipid metabolism and blood pressure regulation. Lastly, the review addresses how MS influences the metabolism and pharmacodynamics of anaesthetic drugs, offering insights into future research and clinical strategies to enhance anaesthetic management in MS patients.