Laparoscopic Bariatric Surgery of Super-obese Patient with Intractable Anterior Abdominal Wall Cellulitis: A Rare Challenge to Anaesthesiologist

Obesity has become an epidemic problem worldwide. Obesity and its related comorbidities present a variety of challenges to anaesthesiologist. Bariatric surgery is the best treatment modality for patients who do not respond to dietary restriction and medical management. An anaesthesiologist should be experienced enough to handle the airway, pain, fluid management and acidosis in the obese patients undergoing bariatric surgery. Laparoscopic vertical sleeve gastrectomy for weight loss was planned for a 48-year-old, super-obese male patient (weight 187 kg, height 155 cm, BMI 77 kg/m(2)) with anterior abdominal wall cellulitis which was not responding to antibiotics. On pre-operative examination, patient had a short thick neck, Grade 3 mallampati class, mild obstructive sleep apnoea and hypertension. Patient was given trial of Continuous Positive Airway Pressure (CPAP) in pre-operative period. Induction of anaesthesia was done in the semi-sitting position. Maintenance was provided with desflurane, oxygen/air mixture and dexmedetomidine infusion. However, patient had delayed recovery. Extubation was done on return of spontaneous ventilation and when patient was awake. He was initially put on CPAP and later on, reintubation was done as he was unable to maintain saturation in immediate post-operative period.