Anaesthetic implications in a case of super obesity with multiple comorbidities: A conundrum of challenges

Abstract

The fast paced lifestyle with no control over diet and lack of exercise has led to rapid rise in obesity in worldwide population. India being a developing country is no exception to this.A body mass index (BMI) ≥50 kg m, referred to as super obese necessitates optimum anaesthetic expertise during perioperative period. We faced a conundrum of challenges while managing a case of necrotizing fascitis in a superobese patient with multiple comorbidities.Peripheral nerve block was an ideal technique for this patient but for local site skin infection and deep nerve location, spinal anaesthesia with 5 inch (12.7 cm) spinal needle was administered.Regional anaesthesia in obese patients comes with a lot of difficulties including localizing the intervertebral space, narrow subarachnoid space, increased pressure, positioning the patient. Restricted fluid intake due to acute kidney injury leading to decreased preload compounds the above factors.