Anesthetic Management of Extreme Obesity: A Case Study

Nicolas Mario Mas D Alessandro; Elise Landsbergen; Vipul Dhumak

doi:doi:10.11648/j.ijacm.20251301.17

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Anesthetic Management of Extreme Obesity: A Case Study

Nicolas Mario Mas D Alessandro^*

, Elise Landsbergen

, Vipul Dhumak

Published in International Journal of Anesthesia and Clinical Medicine (Volume 13, Issue 1)

Received: 26 March 2025 Accepted: 16 April 2025 Published: 22 May 2025

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Abstract

Obesity and Autism Spectrum Disorder (ASD) are prevalent conditions that significantly impact anesthetic management due to airway challenges, metabolic risks, and behavioral considerations. Obesity affects 42% of U.S. adults, while ASD prevalence in adults is approximately 2.21%, necessitating tailored perioperative care strategies. We describe the anesthetic management of a 30-year-old male with a BMI of 101.1, weighing 707 lb (320.7 kg), measuring 5'9" (1.75 m) and ASD undergoing dental surgery. Preoperative challenges included obesity-related airway risks and communication barriers due to ASD. Despite preoperative preparation, the patient was uncooperative, requiring anesthesia induction on a transport cart. General anesthesia was administered using a rapid-sequence intubation technique with succinylcholine, and airway management was facilitated with ramp positioning. Intraoperative care included sevoflurane, along with adjunctive infusions of propofol, dexmedetomidine, and boluses of fentanyl. Postoperative recovery was uneventful, with stable vitals and effective pain management. Patients with both obesity and ASD present unique anesthetic challenges, including increased airway management risks and behavioral sensitivities. Effective strategies include individualized preoperative preparation, the use of anxiolytics like midazolam, and vigilant intraoperative monitoring. Postoperative care requires careful pain assessment, as individuals with ASD may express discomfort atypically. This case highlights the importance of interdisciplinary collaboration and adherence to obesity-specific perioperative guidelines to optimize outcomes. Further research is needed to establish tailored guidelines for managing individuals with extreme obesity and ASD undergoing surgical procedures.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 13, Issue 1)
DOI	10.11648/j.ijacm.20251301.17
Page(s)	46-57
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Obesity, Morbid, Autism Spectrum Disorder, Airway Management, Perioperative Care

References

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Alessandro, N. M. M. D., Landsbergen, E., Dhumak, V. (2025). Anesthetic Management of Extreme Obesity: A Case Study. International Journal of Anesthesia and Clinical Medicine, 13(1), 46-57. https://doi.org/10.11648/j.ijacm.20251301.17

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Alessandro, N. M. M. D.; Landsbergen, E.; Dhumak, V. Anesthetic Management of Extreme Obesity: A Case Study. Int. J. Anesth. Clin. Med. 2025, 13(1), 46-57. doi: 10.11648/j.ijacm.20251301.17

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Alessandro NMMD, Landsbergen E, Dhumak V. Anesthetic Management of Extreme Obesity: A Case Study. Int J Anesth Clin Med. 2025;13(1):46-57. doi: 10.11648/j.ijacm.20251301.17

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@article{10.11648/j.ijacm.20251301.17,
  author = {Nicolas Mario Mas D Alessandro and Elise Landsbergen and Vipul Dhumak},
  title = {Anesthetic Management of Extreme Obesity: A Case Study
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {13},
  number = {1},
  pages = {46-57},
  doi = {10.11648/j.ijacm.20251301.17},
  url = {https://doi.org/10.11648/j.ijacm.20251301.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20251301.17},
  abstract = {Obesity and Autism Spectrum Disorder (ASD) are prevalent conditions that significantly impact anesthetic management due to airway challenges, metabolic risks, and behavioral considerations. Obesity affects 42% of U.S. adults, while ASD prevalence in adults is approximately 2.21%, necessitating tailored perioperative care strategies. We describe the anesthetic management of a 30-year-old male with a BMI of 101.1, weighing 707 lb (320.7 kg), measuring 5'9" (1.75 m) and ASD undergoing dental surgery. Preoperative challenges included obesity-related airway risks and communication barriers due to ASD. Despite preoperative preparation, the patient was uncooperative, requiring anesthesia induction on a transport cart. General anesthesia was administered using a rapid-sequence intubation technique with succinylcholine, and airway management was facilitated with ramp positioning. Intraoperative care included sevoflurane, along with adjunctive infusions of propofol, dexmedetomidine, and boluses of fentanyl. Postoperative recovery was uneventful, with stable vitals and effective pain management. Patients with both obesity and ASD present unique anesthetic challenges, including increased airway management risks and behavioral sensitivities. Effective strategies include individualized preoperative preparation, the use of anxiolytics like midazolam, and vigilant intraoperative monitoring. Postoperative care requires careful pain assessment, as individuals with ASD may express discomfort atypically. This case highlights the importance of interdisciplinary collaboration and adherence to obesity-specific perioperative guidelines to optimize outcomes. Further research is needed to establish tailored guidelines for managing individuals with extreme obesity and ASD undergoing surgical procedures.
},
 year = {2025}
}

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TY - JOUR
T1 - Anesthetic Management of Extreme Obesity: A Case Study

AU - Nicolas Mario Mas D Alessandro
AU - Elise Landsbergen
AU - Vipul Dhumak
Y1 - 2025/05/22
PY - 2025
N1 - https://doi.org/10.11648/j.ijacm.20251301.17
DO - 10.11648/j.ijacm.20251301.17
T2 - International Journal of Anesthesia and Clinical Medicine
JF - International Journal of Anesthesia and Clinical Medicine
JO - International Journal of Anesthesia and Clinical Medicine
SP - 46
EP - 57
PB - Science Publishing Group
SN - 2997-2698
UR - https://doi.org/10.11648/j.ijacm.20251301.17
AB - Obesity and Autism Spectrum Disorder (ASD) are prevalent conditions that significantly impact anesthetic management due to airway challenges, metabolic risks, and behavioral considerations. Obesity affects 42% of U.S. adults, while ASD prevalence in adults is approximately 2.21%, necessitating tailored perioperative care strategies. We describe the anesthetic management of a 30-year-old male with a BMI of 101.1, weighing 707 lb (320.7 kg), measuring 5'9" (1.75 m) and ASD undergoing dental surgery. Preoperative challenges included obesity-related airway risks and communication barriers due to ASD. Despite preoperative preparation, the patient was uncooperative, requiring anesthesia induction on a transport cart. General anesthesia was administered using a rapid-sequence intubation technique with succinylcholine, and airway management was facilitated with ramp positioning. Intraoperative care included sevoflurane, along with adjunctive infusions of propofol, dexmedetomidine, and boluses of fentanyl. Postoperative recovery was uneventful, with stable vitals and effective pain management. Patients with both obesity and ASD present unique anesthetic challenges, including increased airway management risks and behavioral sensitivities. Effective strategies include individualized preoperative preparation, the use of anxiolytics like midazolam, and vigilant intraoperative monitoring. Postoperative care requires careful pain assessment, as individuals with ASD may express discomfort atypically. This case highlights the importance of interdisciplinary collaboration and adherence to obesity-specific perioperative guidelines to optimize outcomes. Further research is needed to establish tailored guidelines for managing individuals with extreme obesity and ASD undergoing surgical procedures.

VL - 13
IS - 1
ER -

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Author Information

Nicolas Mario Mas D Alessandro

Department of Anesthesiology and Pain Management, The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio, US

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http://orcid.org/0000-0002-1182-6399
Elise Landsbergen

Department of Anesthesiology and Pain Management, The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio, US

Contact Email

http://orcid.org/0009-0007-9899-5542
Vipul Dhumak

Department of Anesthesiology and Pain Management, The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio, US

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http://orcid.org/0009-0000-4499-8325

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Alessandro, N. M. M. D., Landsbergen, E., Dhumak, V. (2025). Anesthetic Management of Extreme Obesity: A Case Study. International Journal of Anesthesia and Clinical Medicine, 13(1), 46-57. https://doi.org/10.11648/j.ijacm.20251301.17

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ACS Style

Alessandro, N. M. M. D.; Landsbergen, E.; Dhumak, V. Anesthetic Management of Extreme Obesity: A Case Study. Int. J. Anesth. Clin. Med. 2025, 13(1), 46-57. doi: 10.11648/j.ijacm.20251301.17

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AMA Style

Alessandro NMMD, Landsbergen E, Dhumak V. Anesthetic Management of Extreme Obesity: A Case Study. Int J Anesth Clin Med. 2025;13(1):46-57. doi: 10.11648/j.ijacm.20251301.17

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@article{10.11648/j.ijacm.20251301.17,
  author = {Nicolas Mario Mas D Alessandro and Elise Landsbergen and Vipul Dhumak},
  title = {Anesthetic Management of Extreme Obesity: A Case Study
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {13},
  number = {1},
  pages = {46-57},
  doi = {10.11648/j.ijacm.20251301.17},
  url = {https://doi.org/10.11648/j.ijacm.20251301.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20251301.17},
  abstract = {Obesity and Autism Spectrum Disorder (ASD) are prevalent conditions that significantly impact anesthetic management due to airway challenges, metabolic risks, and behavioral considerations. Obesity affects 42% of U.S. adults, while ASD prevalence in adults is approximately 2.21%, necessitating tailored perioperative care strategies. We describe the anesthetic management of a 30-year-old male with a BMI of 101.1, weighing 707 lb (320.7 kg), measuring 5'9" (1.75 m) and ASD undergoing dental surgery. Preoperative challenges included obesity-related airway risks and communication barriers due to ASD. Despite preoperative preparation, the patient was uncooperative, requiring anesthesia induction on a transport cart. General anesthesia was administered using a rapid-sequence intubation technique with succinylcholine, and airway management was facilitated with ramp positioning. Intraoperative care included sevoflurane, along with adjunctive infusions of propofol, dexmedetomidine, and boluses of fentanyl. Postoperative recovery was uneventful, with stable vitals and effective pain management. Patients with both obesity and ASD present unique anesthetic challenges, including increased airway management risks and behavioral sensitivities. Effective strategies include individualized preoperative preparation, the use of anxiolytics like midazolam, and vigilant intraoperative monitoring. Postoperative care requires careful pain assessment, as individuals with ASD may express discomfort atypically. This case highlights the importance of interdisciplinary collaboration and adherence to obesity-specific perioperative guidelines to optimize outcomes. Further research is needed to establish tailored guidelines for managing individuals with extreme obesity and ASD undergoing surgical procedures.
},
 year = {2025}
}

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TY - JOUR
T1 - Anesthetic Management of Extreme Obesity: A Case Study

VL - 13
IS - 1
ER -

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