Anesthetic Management of a Patient with Class III Obesity Undergoing Bariatric Surger per Laparoscopic

Abstract

Background : Class III obesity presents significant perioperative challenges due to altered respiratory physiology, increased risk of difficult airway, aspiration, and postoperative respiratory complications. Laparoscopic surgery further increases these challenges through pneumoperitoneum, which can impair respiratory mechanics and increase carbon dioxide load. Optimal airway management, positioning, ventilation, and postoperative respiratory support are therefore essential.

Case Illustration : A 31-year-old man with class III obesity (BMI 51.6 kg/m²) underwent laparoscopic esophagectomy and gastrectomy under general anesthesia. The patient was positioned in the ramp position and preoxygenated with 100% oxygen for 5 minutes. Anesthesia was induced with propofol 200 mg and fentanyl 200 μg. Following confirmation of adequate mask ventilation, atracurium 50 mg was administered. Tracheal intubation was successfully performed after induction according to the 2022 American Society of Anesthesiologists Difficult Airway Algorithm. Controlled mechanical ventilation was maintained at 12 breaths/min with PEEP of 6 cmH₂O and a minute ventilation of 6.4 L/min. Anesthesia was maintained with sevoflurane 2–3 vol% in an oxygen–air mixture with FiO₂ 50%. Postoperatively, the patient remained mechanically ventilated with stable hemodynamics and was transferred to the high-care unit. Analgesia consisted of fentanyl 25 μg/hour and paracetamol 1 g every 6 hours.

Conclusion : Perioperative management of patients with class III obesity undergoing laparoscopic surgery requires meticulous airway planning, optimal positioning, lung-protective ventilation, and appropriate postoperative respiratory support. A structured approach based on difficult airway guidelines can facilitate successful airway management.