Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2022

Open Access 01-12-2022 | Obesity | Case report

Anesthetic management of a severely obese patient (body mass index 70.1 kg/m2) undergoing giant ovarian tumor resection: a case report

Authors: Shoko Yamochi, Mao Kinoshita, Teiji Sawa

Published in: Journal of Medical Case Reports | Issue 1/2022

Login to get access

Abstract

Background

Giant ovarian tumors are rarely seen with severe obesity. There are few reports of perioperative management of giant ovarian tumors and severe obesity. Here, we report the perioperative management of physiological changes in massive intraabdominal tumors in a patient with severe obesity.

Case presentation

A 46-year-old Japanese woman (height 166 cm, weight 193.2 kg; body mass index 70.1 kg/m2) was scheduled to undergo laparotomy for a giant ovarian tumor. The patient was placed in the ramp position. Preoxygenation was performed using a high-flow nasal cannula, and awake tracheal intubation was performed using a video laryngoscope. Mechanical ventilation using a limited tidal volume with moderate positive end-expiratory pressure was applied during the surgical procedure. The aspiration speed for 15 L of tumor aspirate was set to under 1 L/minute, and the possibility of reexpansion pulmonary edema was foreseen by conventional monitoring.

Conclusions

We successfully completed anesthetic management in a patient with concomitant severe obesity and giant ovarian tumors.
Literature
1.
Shah U, Wong J, Wong DT, Chung F. Preoxygenation and intraoperative ventilation strategies in obese patients: a comprehensive review. Curr Opin Anaesthesiol. 2016;29:109–18.CrossRefPubMed
2.
Juvin P, Lavaut E, Dupont H, Lefevre P, Demetriou M, Dumoulin JL, et al. Difficult tracheal intubation is more common in obese patients than in lean patients. Anesth Analg. 2003;97:595–600.CrossRefPubMed
3.
JSA airway management guideline 2014. Improving the safety of anesthesia induction. Japanese Society of Anesthesiologists. J Anesth. 2014;28(4):482–93.
4.
Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized controlled trial of nasal oxygen administration. J Clin Anesth. 2010;22:164–8.CrossRefPubMed
5.
Baraka AS, Taha SK, Siddik-Sayyid SM, Kanazi GE, El-Khatib MF, Dagher CM, et al. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia. 2007;62:769–73.CrossRefPubMed
6.
Berthoud MC, Peacock JE, Reilly CS. Effectiveness of preoxygenation in patients with morbid obesity. Br J Anaesth. 1991;67:464–6.CrossRefPubMed
7.
Altermatt FR, Muoz HR, Delfino AE, Cortinez LI. Preoxygenation in obese patients: effects of position on apnoea tolerance. Br J Anaesth. 2005;95:706–9.CrossRefPubMed
8.
Dixon BJ, Dixon JB, Carden JR, Burn AJ, Schachter LM, Playfair JM, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized trial. Anesthesiol. 2005;102(6):1110–5.CrossRef
9.
Couture EJ, Provencher S, Somma J, Lellouche F, Marceau S, Bussires JS. Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial. Can J Anaesth. 2018;65:522–8.CrossRefPubMed
10.
Wong DT, Dallaire A, Singh KP, Madhusudan P, Jackson T, Singh M, Wong J, Chung F. High-flow nasal oxygen improves safe apnea time in morbidly obese patients undergoing general anesthesia: a randomized controlled trial. Anesth Analg. 2019;129(4):1130–6.CrossRefPubMed
11.
Shinohara H, Ishii H, Kakuyama M, Fukuda K. Morbidly obese patient with a huge ovarian tumor who was intubated while awake using airway scope in lateral decubitus position. Masui. 2010;59(5):625–8.PubMed
12.
Imada Y, Egi M, Kubota K, Kitahara J, Izuta S, Mizobuchi S. Preoperative percutaneous drainage using a double-balloon catheter with measurement of pressure in a patient with giant ovarian tumor. Masui. 2020;69:319–23.
13.
Clark K, Lam LT, Gibson S, Currow D. The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials. Anaesthesia. 2009;2009(64):652–7.CrossRef
14.
Nestler C, Simon P, Petroff D, Hammermuller S, Kamrath D, Wolf S, Dietrich A, Camilo LM, Beda A, Carvalho AR, Giannella-Neto A, Reske AW, Wrigge H. Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography. Br J Anaesth. 2017;119:1194–205.CrossRefPubMed
15.
De Jong A, Wrigge H, Hedenstierna G, Gattinoni L, Chiumello D, Frat J-P, Ball L, Schetz M, Pickkers P, Jaber S. How to ventilate obese patients in the ICU. Intensive Care Med. 2020;46:2423–35.CrossRefPubMed
16.
Kim YT, Kim JW, Choe BH. A case of huge ovarian cyst of 21-year-old young woman. J Obstet Gynaecol Res. 1999;25:275–359.CrossRefPubMed
17.
Einenkel J, Alexander H, Schotte D, Stumpp P, Horn LC. Giant ovarian cysts: is a pre and intraoperative drainage an advisable procedure? Int J Gynecol Cancer. 2006;16:2039–43.CrossRefPubMed
18.
Ikeda T, Kurasako N, Nishitani K, Okada S, Arai T. Anesthetic management for removal of a giant ovarian tumor using FloTracTM VigileoTM monitoring system. Masui. 2014;63:439–42.PubMed
19.
Akazawa M, Saito T, Nagayama R, Ariyoshi K, Okadome M. Management of a giant ovarian tumor more than 30 kg: a case report and review of the literature. J Gynecol Surg. 2018;34:243–7.CrossRef
20.
Ishida Y, Nakazawa K, Okada T, Tsuzuki Y, Kobayashi T, Yamada R, Uchino H. Anesthetic management of a morbidly obese patient with endometrial cancer during robot-assisted laparoscopic surgery. JA Clin Rep. 2021;7(1):30.CrossRefPubMedPubMedCentral
Metadata
Title
Anesthetic management of a severely obese patient (body mass index 70.1 kg/m2) undergoing giant ovarian tumor resection: a case report
Authors
Shoko Yamochi
Mao Kinoshita
Teiji Sawa
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2022
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-022-03383-x

Other articles of this Issue 1/2022

Journal of Medical Case Reports 1/2022 Go to the issue

Case report

A large pericardial cystic lymphangioma presenting as acute-onset respiratory distress in a child: a case report

Case report

Long-term survival after definitive proton beam therapy for oligorecurrent esophageal squamous cell carcinoma: a case report

Case report

Delayed percutaneous coronary intervention for an extensive iatrogenic left main coronary artery dissection: a case report

Case report

A novel homozygous missense variant p.D339N in the PKLR gene correlates with pyruvate kinase deficiency in a Pakistani family: a case report

Case report

Giant desmoid tumour mimicking recurrent uterine myoma in a nulliparous young Nigerian: a case report

Case report

Electroacupuncture as an effective therapy for Tapia’s syndrome after transoral intubation for general anesthesia: a case report and review of the literature