Abstract SNACC-99

Return to Poster Listing

Sitting Craniotomy in a Super Morbidly Obese patient

Gorji R, Fjotland C, Yang Z, Deshaies E, Singla A, Krishnamurthy S, Li F
Upstate Medical University, Syracuse, NY, US

Craniotomy in a sitting position is used for resection of occipital lobe tumors. It offers the surgeon a clean operative field, good anatomical orientation and wider operative fields despite the major risk of air embolism. We report the case of a 64 year-old male presenting for cranial resection of a metastatic occipital renal cell carcinoma. Medical history is significant for history of hypertension, obstructive sleep apnea, hyperlipidemia and super morbid obesity (BMI 59). Airway was classified as Mallampati class 2. The patient was induced and intubated in a rapid sequence fashion (propofol, succinylcholine) using a video laryngoscope without incident. A 10FR cordis was inserted in the left subclavian vein. A second central line (multi-orificed central line) was placed and its position confirmed by x-ray. Patient was then positioned in a sitting position. A transesophageal echocardiogram probe was placed in the esophagus and a transthoracic precordial doppler probe were applied to detect for venous air embolism. The TEE and Doppler probe were monitored throughout the procedure. An arterial line was placed in the right radial artery. Anesthesia was maintained by fentanyl infusion with isoflurane in oxygen. Following 7 hours of surgery and tumor resection, the patient was successfully extubated and taken to the PACU and to the NICU subsequently. With careful planning and monitoring as well as appreciation to the pathophysiology of morbid obesity, sitting craniotomies can be performed on morbidly obese patients despite the many risks and pitfalls.

  • SNACC-99 Image 3
  • SNACC-99 Image 2
  • SNACC-99 Image 1

Back to Top