Anesthesiologists are increasingly confronted with athletes in a perioperative setting. The right choice of type of anesthesia technique, pain management of injuries, specific physiologic adaptations of the athlete and knowledge of prohibited substances are eminent for a correct approach of this subpopulation.

An anesthesiologist should recognize the most common benign ECG findings in athletes like bradycardia, isolated left ventricle hypertrophy on voltage criteria and early repolarization as normal features in the athlete’s heart. Isotonic physiology typically produces four chamber dilation. In contrast, isometric stress creates high intravascular pressure leading to left ventricular hypertrophy. Preoperative evaluation should also identify possible consumers of performance-enhancing drugs. Intraoperative points of interest for the anesthesiologist are mainly avoiding drugs on the prohibited list of the world anti-doping agency (WADA). Post-operative and chronic pain management are still developing fields in this population. The International Olympic Committee (IOC) proposed treating acute pain with a combination of paracetamol, NSAIDs, topical analgesics, injectable NSAIDs and local anesthetics. It may be suggested that chronic pain management in elite athletes could benefit from treatment in specialized multidisciplinary pain clinics.

Although elite athletes are amongst the fittest people on earth, unique characteristics of this population requires careful preoperative evaluation and perioperative management. Chronic pain management in athletes is a developing field with a need for further expert.