Awake Video Laryngoscopy Endotracheal Intubation and Self Positioning in Super Obese Neurosurgery Patient: A Case Report

Abstract

Safe conduct of anesthesia in a case of super obese patient, weighing 165 kgs posted for neurosurgical procedure and overcoming the challenges faced in these kind of patients. A 23 year old male presented with complaints of headache, one episode of seizure and was diagnosed to have left Cerebellopontine angle tumour. Patient is a case of recently diagnosed diabetic and systemic hypertension. Patient is super obese with weight of 165 kg and height of 179 cm. BMI calculated as 51.6. Patient was planned by the Neurosurgery team for tumour excision under anesthesia. Securing a definite airway in these patients are challenging. Awake video laryngoscopy endotracheal intubation with self-positioning of the patient was decided as the primary anesthesia plan for securing the airway.Anticipating Difficult mask ventilation and difficult intubation for our patient, we decided to do awake video laryngoscopy guided endotracheal intubation. This technique was chosen instead of awake fiberoptic intubation because the patient has adequate mouth opening and the patient discomfort and risk of raising ICP is less comparatively with this technique, however we had a fiberoptic bronchoscope on standby in case of emergency. Anesthetizing the airway plays important role in preventing unwanted gag reflexes and patient discomfort.With thorough preoperative assessment, optimization of the patient preoperatively, deciding on a step wise anesthesia plan, preparing of all expected complications, we were able to successfully complete the surgery in safe and uneventful manner in spite of many high risk factors of the patient.