ANAESTHETIC MANAGEMENT OF A CASE OF MORBID OBESITY POSTED FOR LAPAROSCOPIC CHOLECYSTECTOMY

Introduction: Managing anesthesia in obese patients can be challenging due to anatomical and physiological changes that may contribute to airway difculties. This case report presents a case of a morbidly obese patient undergoing laparoscopic cholecystectomy, emphasizing the anesthetic considerations and strategies used to ensure a safe and effective perioperative period. Case Report: A 30-year-old morbidly obese female (BMI: 42 kg/m²) was scheduled for elective laparoscopic cholecystectomy. Given her obesity-related challenges, a difcult airway was anticipated.On examination, vitals were stable. Abdominal examination revealed tenderness in right upper quadrant. Blood investigations were normal. Transabdominal sonography showed numerous calculi in CBD and gall bladder. A plan of administering General anaesthesia with epidural anaesthesia for the patient was made. Preoperatively optimization was done by advising NPO, antiaspiration prophylaxis. In the OT, all standard monitors were attached. Adequate preloading done. GA was chosen as the mode of anaesthesia. Preoperative Preparation included securing IV access , antiemetics and anticholinergics were administered. Difcult airway cart was kept ready. Induction & Airway Management was achieved through Sedation with midazolam, propofol, and fentanyl. Succinylcholine for rapid relaxation, followed by intubation with a 7.5mm exometallic tube was done. Maintenance & Monitoring achieved through Vecuronium for muscle relaxation, anaesthesia maintained with nitrous oxide, oxygen, and sevourane. Continuous monitoring of EtCO₂ (30-35 mmHg) and vital signs were carried out. Extubation & Recovery was achieved by Reversal with neostigmine and glycopyrrolate. Patient extubated safely after regaining protective airway reexes. Conclusion: Securing airway and anaesthetic techniques ensured a smooth perioperative course. The RAMP position was crucial in optimizing airway management. This case underscores the importance of careful preoperative planning in morbidly obese patients