ANESTHESIA IN A PATIENT WITH MORBID OBESITY: A CLINICAL CASE REPORT
Keywords:
general anesthesia; morbid obesity; difficult airway; obstructive sleep apnea; laparoscopic cholecystectomy; case reportAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0888
Abstract
Background: Morbid obesity increases anesthetic complexity through respiratory impairment, difficult airway risk, reduced functional residual capacity, frequent obstructive sleep apnea and pharmacokinetic changes requiring individualized drug dosing. Transparent case reporting may help describe safe perioperative strategies for high-risk scenarios. Case presentation: This is a clinical case of a 44-year-old woman with extreme morbid obesity, body mass index 57.5 kg/m2, controlled hypertension, gastroesophageal reflux disease and high probability of obstructive sleep apnea, scheduled for elective laparoscopic cholecystectomy. Preoperative assessment showed Mallampati class III, neck circumference of 48 cm, baseline oxygen saturation of 93% and STOP-Bang score of 6/8. Balanced general anesthesia was planned with optimized preoxygenation, ramped positioning, videolaryngoscopy, protective ventilation based on ideal body weight, opioid-sparing multimodal analgesia and awake extubation followed by non-invasive ventilatory support in the post-anesthesia care unit. Results: Tracheal intubation was successful on the first attempt using a videolaryngoscope. The lowest oxygen saturation during induction was 95%. The surgical time was 92 minutes, with no clinically relevant hemodynamic instability, aspiration, hypoxemia or need for postoperative invasive ventilation. The patient left the post-anesthesia care unit with an Aldrete score of 9/10 and was discharged 24 hours after surgery. No respiratory or cardiovascular complications were recorded in the 7- and 30-day follow-up. Conclusion: In patients with morbid obesity, anesthetic safety relies on targeted preoperative assessment, rational weight scalar selection for drug dosing, anticipated airway planning, protective ventilation and close postoperative surveillance.
Keywords: general anesthesia; morbid obesity; difficult airway; obstructive sleep apnea; laparoscopic cholecystectomy; case report.
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