Anesthetic management of a morbidly obese patient in prone position for lumbar laminectomy

: A 22-year-old man weighing 188.7kg, 170cm tall (body mass index 65.2 kg x m(-2)) with bladder and rectal disturbances due to lumbar disc hernia (L4/5 and L5/S1) was scheduled for L4-5 laminectomy under general anesthesia. Awake fiberoptic intubation was attempted to prevent airway obstruction because we predicted difficult airway. During fiberoptic tracheal intubation, we easily succeeded in the insertion of the fiberscope itself into the trachea, and we succeeded in placing the reinforced tube into the trachea. Fentanyl and sugammadex were calculated with total body weight, but, remifentanil, propofol, and rocuronium were re-calculated with ideal body weight. They were given intravenously. Anesthesia was maintained with sevoflurane (1.5 to 2.0%), the fraction of inspiratory oxygen (about 0.6), remifentanil (0.1 to 0.4 microg x kg(-1) x min(-1)), and fentanyl (100 to 150 microg) as needed. After turning to prone position, severe physiological abnormal signs were not recognized. We concluded that awake fiberoptic intubation was useful and safe; moreover, anesthetic agents were administrated appropriately for morbid obesity.