Anesthesia for Craniotomy Tumor Removal Patient with Morbid Obesity

Abstract

Purpose: Obesity is one of the greatest health challenges in the western world. Obesity is defined as a body mass index (BMI) >30 kg/m2, with BMI >35 and >55 kg/m2 considered ‘morbidly’ obese and ‘super morbidly’ obese, respectively. The aim of this study was to examine anesthetic management for craniotomy tumor removal in patients with morbid obesity.   Design/methodology/data analysis: This research uses a qualitative descriptive research method with a case study approach of a 39 year old female patient with a body weight of 110 kg, height 160 cm, and body mass index (BMI) 42.9 kg/m2, Mallampati score 2, thyromental distance > 3 fingers hospitalized for removal of meningioma. Data collection techniques in this research used literature study, observation and laboratory tests. The data that has been collected is then analyzed descriptively.   Findings: The results of the study showed that in the operating room, the patient was positioned in a neutral position 300 head up and Ramp. Preoxygenation with 100% O2 was performed via a face mask. Anesthesia was maintained with continuous intravenous propofol 25-50 μg/kg/min, intravenous rocuronium 40 mg/h, and volatile anesthesia using sevoflurane 0.5-1%vol with oxygen: air at a fraction of 50%. Monitoring during surgery includes evaluation of systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, oxygen saturation, ECG waves, EtCO2, and urine output. The operation lasted 4 hours in the supine position. Post-surgery patients are then treated in the Intensive Care Unit (ICU) for one day before being transferred to the ward and finally to a regular room. He received treatment for 5 days before being discharged. Problems faced during anesthesia in obese patients are airway management, ventilation, position, drug dosage, presence of comorbidities and post-operative care for recovery from anesthesia and surgery.   Originality/value: While addressing common challenges encountered during anesthesia in obese patients, this research takes a step further by proposing innovative solutions. The study acknowledges the complexities of airway management, ventilation, positioning, drug dosage, comorbidities, and post-operative care. However, it introduces novel considerations or techniques to mitigate these challenges, possibly involving emerging technologies or interdisciplinary collaboration for enhanced patient outcomes.   Practical  implications: The practical implications of this research advocate for a nuanced and individualized approach to anesthetic management in morbidly obese patients undergoing craniotomy tumor removal, fostering improved patient care and safety.