Anesthetic Management in a Pregnant Woman With Super Morbid Obesity and Severe Obstructive Sleep Apnea Syndrome Undergoing Cesarean Section: A Case Report

Pregnant women with super morbid obesity (Class III obesity) and severe obstructive sleep apnea syndrome (SAS) undergoing cesarean section present significant anesthetic challenges. Although the ramped position (RAMP) and noninvasive positive pressure ventilation (NPPV) may optimize respiratory function, their intraoperative use in this population is not widely reported. A 36-year-old pregnant woman with obesity (BMI = 50 kg/m²) and severe SAS underwent cesarean section under combined spinal-epidural anesthesia. RAMP and bilevel positive airway pressure (BiPAP) were employed to optimize respiratory function. Despite achieving a T4 sensory blockade, the prolonged duration of surgery resulted in upper abdominal pain, necessitating propofol sedation. This led to respiratory depression, which was successfully managed by adjusting the BiPAP settings. RAMP and NPPV, particularly BiPAP, may be beneficial in optimizing respiratory management during cesarean section in pregnant women with super morbid obesity and severe SAS, especially in cases requiring unexpected sedation.