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Beyond the Block: Sequential Spinal Anesthesia and Dexmedetomidine-Ketamine TIVA for a Four-Hour Cesarean Section in a 157-kg Parturient

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Sequential spinal and TIVA techniques maintained hemodynamic stability during surgery despite complications.
The case underscores the importance of anesthetic adaptability in high-risk obstetric scenarios, particularly in super-obese patients.
A multidisciplinary approach facilitated rapid decision-making, ensuring patient safety and effective management during a complex cesarean section.
Planning for anesthetic transitions is essential to avoid airway risks while managing unexpected surgical prolongation.

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Case report highlights safe anesthetic strategies for cesarean delivery in super-obese parturients, suggesting TIVA may be a viable option.

Nugroho et al. (2025) studied this question.

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Case report highlights safe anesthetic strategies for cesarean delivery in super-obese parturients, suggesting TIVA may be a viable option.