Anesthetic management of a severely obese patient (body mass index 70.1 kg/m(2)) undergoing giant ovarian tumor resection: a case report

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/m(2)) 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.