title: Perioperative management and monitoring of a super-obese patient.
abstract: Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients. We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. Anesthesia was maintained with desflurane and remifentanil. Desflurane was titrated on BIS values, whereas remifentanil was based on hemodynamic monitoring (invasive arterial pressure and HemoSonic). Rocuronium was administered based on ideal body weight and recovery of twitch tension. Safe and rapid extubation in the operating theatre was made possible by the use of short-acting agents coupled with continuous intraoperative monitoring. Recovery in the post-anesthesia care unit was uneventful, pain was managed with meperidine, and after 5 hours the patient was discharged to the surgical ward. Oxygen therapy and SpO2 monitoring were continued overnight. No desaturation episodes were recorded. Pain was managed with I.V. drip of ketorolac and tramadole.
authors.affiliation: Department of Anesthesia, Pain, Perioperative Medicine and Intensive Care, Santa Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pellis
authors.forename: Yigal
authors.initials: Y
authors.lastname: Leykin
authors.forename: Giovanni
authors.initials: G
authors.lastname: Albano
authors.forename: Gianfederico
authors.initials: G
authors.lastname: Zannier
authors.forename: Gabriella
authors.initials: G
authors.lastname: Di Capua
authors.forename: Bernardo
authors.initials: B
authors.lastname: Marzano
authors.forename: Antonino
authors.initials: A
authors.lastname: Gullo
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods; D015992:Body Mass Index; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000601:surgery*; D019990:Perioperative Care; D011182:Postoperative Care / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome