The impact of drug selection on patient outcomes in anesthesia and postoperative care: a narrative review

Purpose: Anesthesiology has evolved from a discipline focused primarily on ensuring intraoperative survival to one that promotes recovery, minimizes complications, and improves long-term outcomes. Drug choice is central to this shift, as it directly affects both immediate and long-term patient results. This review summarizes current evidence on anesthetic drug selection and its clinical implications.Current concepts: Enhanced recovery after surgery (ERAS) emphasizes opioid-sparing strategies and multimodal analgesia, with agents such as propofol, dexmedetomidine, and lidocaine supporting early mobilization and recovery. Sugammadex enables rapid and reliable reversal of neuromuscular blockade, reducing residual paralysis and associated respiratory complications. Remimazolam offers predictable recovery and hemodynamic stability, making it particularly valuable in older or high-risk patients. Beyond perioperative outcomes, precision anesthesia integrates factors such as frailty, sarcopenia, pharmacogenomics, and oncological considerations, suggesting that anesthetic management may influence long-term survival and quality of life.Discussion and conclusion: Anesthetic drug selection should be recognized as a key determinant of patient recovery and prognosis. Integrating ERAS principles, neuromuscular monitoring with sugammadex, and emerging agents such as remimazolam within a precision anesthesia framework can guide safer and more individualized clinical practice.