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CC BY 4.0 · J Neuroanaesth Crit Care
DOI: 10.1055/s-0044-1782503
Case Report

Challenges of Super-Super Obese Patient Presenting for Neurosurgery: A Case-Based Review

Sapna Suresh 
1   Department of Anesthesiology and Critical care, Neuroanesthesia and Critical Care, Aster Medcity, Kochi, India
,
Ajay P. Hrishi 
2   Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
,
Ashitha Arumadi 
2   Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
,
Ranganatha Praveen 
2   Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Abstract

With the rising prevalence of extreme obesity, their perioperative neurosurgical management demands special attention. We report the case of an acromegalic male with a body mass index as high as 64.12 kg/m2 who presented for craniotomy and resection of a pituitary tumor under general anesthesia. Through this report, we introduce the readers to this newer concept of the highest grade of obesity in the context of neurosurgery, explain the perioperative concerns, and reiterate the need for careful drug dosing, ventilation targets, positioning requirements, thorough cardiac and airway evaluation, and preparedness for adverse events. This report also highlights the fact that a well-planned and managed case can still turn out uneventful in the presence of multiple comorbidities like diabetes mellitus, adrenocortical insufficiency, hypothyroidism, and acromegaly. Advances in airway management, regional anesthesia, and perioperative point-of-care ultrasound have made it possible to formulate a safe anesthetic plan tailored to the patient's needs.

Keywords

acromegaly - anesthesia - neurosurgery - POCUS - super-super obesity


Publication History

Article published online:
09 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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