Lehmeidi Yazen, Beck Neto Theodoro
Anesthesia and Critical Care, SUNY Downstate College of Medicine, New York, USA.
Anesthesiology and Perioperative Medicine, SUNY Downstate College of Medicine, New York, USA.
Cureus. 2025 Aug 21;17(8):e90661. doi: 10.7759/cureus.90661. eCollection 2025 Aug.
Known for its role in energy metabolism and neuromuscular performance, creatine monohydrate is a widely used supplement among athletes and the expanding population of weightlifters. The basis of its use relies on its role in increasing the amount of available ATP, the energy currency of our bodies. Many commonly used anesthetics cause decreases in ATP levels, raising the question of whether creatine may influence the anesthetic process. Despite its popularity and its direct role in providing cellular energy, the effects of creatine supplementation on anesthesia remain underexplored and not completely understood, emphasizing the need for this literature review. Athletes, a demographic with high creatine supplementation use, are also at elevated risk for musculoskeletal injuries requiring surgical interventions and general anesthesia. Therefore, understanding how chronic creatine use might influence anesthetic outcomes, such as induction time, anesthetic depth, emergence, and hemodynamic stability, is a relevant question with limited available data. This further highlights the need for increased awareness among anesthesiologists regarding creatine use and calls for prospective studies to determine whether supplementation meaningfully alters anesthetic requirements or outcomes. Understanding this interaction may inform preoperative screening and guide personalized anesthesia approaches in a health-conscious surgical population. This review was conducted to assess the current state of evidence on how creatine may affect anesthetic depth, recovery profiles, and perioperative physiology. A comprehensive literature search was performed across PubMed, Scopus, and Embase using relevant terms. Studies were screened for relevance, resulting in 25 included articles, primarily preclinical studies. Findings suggest that creatine may influence anesthetic pharmacodynamics by modulating intracellular energy stores, calcium handling, nitric oxide signaling, and synaptic function. Animal models show variable responses to anesthetics such as sevoflurane and propofol following creatine preloading, including altered bispectral index (BIS) scores and delayed emergence. However, human data are lacking, and although current clinical practice generally assesses supplement use during preoperative evaluation, creatine use is rarely specifically asked about or considered when dosing.
肌酸一水合物因其在能量代谢和神经肌肉功能方面的作用而闻名，是运动员和不断增加的举重人群中广泛使用的一种补充剂。其使用的依据在于它在增加可用ATP（我们身体的能量货币）数量方面所起的作用。许多常用麻醉剂会导致ATP水平下降，这就引发了一个问题，即肌酸是否会影响麻醉过程。尽管肌酸很受欢迎且在提供细胞能量方面有直接作用，但补充肌酸对麻醉的影响仍未得到充分研究且尚未完全了解，这凸显了进行这篇文献综述的必要性。运动员是肌酸补充剂使用比例较高的人群，他们因肌肉骨骼损伤而需要手术干预和全身麻醉的风险也更高。因此，了解长期使用肌酸如何影响麻醉效果，如诱导时间、麻醉深度、苏醒和血流动力学稳定性，是一个现有数据有限的相关问题。这进一步凸显了麻醉医生提高对肌酸使用认识的必要性，并呼吁进行前瞻性研究，以确定补充肌酸是否会显著改变麻醉需求或效果。了解这种相互作用可能会为术前筛查提供信息，并指导对注重健康的手术人群采取个性化的麻醉方法。本综述旨在评估关于肌酸如何影响麻醉深度、恢复情况和围手术期生理的现有证据状态。使用相关术语在PubMed、Scopus和Embase上进行了全面的文献检索。对研究进行相关性筛选，最终纳入25篇文章，主要是临床前研究。研究结果表明，肌酸可能通过调节细胞内能量储备、钙处理、一氧化氮信号传导和突触功能来影响麻醉药效学。动物模型显示，在预先加载肌酸后，对七氟醚和丙泊酚等麻醉剂会有不同的反应，包括双谱指数（BIS）评分改变和苏醒延迟。然而，缺乏人体数据，并且尽管目前的临床实践通常在术前评估时会评估补充剂的使用情况，但在给药时很少专门询问或考虑肌酸的使用情况。
