Abstract
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.