[Perioperative management of a morbidly obese patient with sleep apnea syndrome].

A 34-year-old male, weighing 110 kg, with severe obstructive sleep apnea syndrome (OSAS) was urgently taken to the hospital for heart and respiratory failure. His body mass index was 39, showing that he was mobidly obese. He was scheduled for tonsillectomy under general anesthesia. BiPAP (bi-level positive airway pressure) system was applied for respiratory assist. He went on a diet to prepare for the surgery. Preoperative examination revealed that the neck was short, and the tongue and tonsils were hypertrophic. Since we expected difficulty in maintaining upper airway open during the perioperative period, anesthesia was induced with fentanyl and propofol, and fiberscopic intubation was performed by preserving spontaneous breathing. Postoperatively he was taken to the intensive care unit and was mechanically ventilated for 6 days because pharyngeal edema could aggravate his respiratory condition when extubated just after the surgery. He was successfully extubated and BiPAP was applied in the same day. We recommend that the patient with morbidly obese OSAS should be cared intensively during perioperative period.