CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 3  |  Page : 361-363

Feasibility of THRIVE oxygenation and intra-operative lung-protective ventilation in morbidly obese patients undergoing neurosurgical procedures


Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India

Correspondence Address:
Balaji Vaithialingam
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka - 560029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_198_22

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The conduct of anesthesia in morbidly obese patients undergoing neurosurgical procedures can be challenging considering the multi-system organ involvement. Implementation of conventional lung-protective ventilation in morbidly obese patients can have a negative impact on the intra-cranial dynamics. We report a series of three patients with morbid obesity and a difficult airway for the neurosurgical procedure. The patients were oxygenated with high-flow oxygen devices to ensure an adequate oxygen reserve in the peri-operative period. A modified intra-operative lung-protective ventilation with normocarbia was implemented with no impact on the intra-cranial pressure in the prone position in two of the patients. Oxygenation with high-flow devices should be considered during the peri-operative period in morbidly obese patients to avert an adverse respiratory event, and a modified lung-protective ventilation technique is feasible with normal intra-cranial dynamics intra-operatively.


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