Awake epidural anesthesia for laparotomy in an obese patient with severe lung disease and difficult airway

Anaesthetizing a patient for laparotomy who has co-existing lung disease, difficult airway and obesity is a major anesthetic challenge. We are describing the anesthetic management of an obese patient suffering from severe interstitial lung disease and a difficult airway who underwent laparotomy for excision of a large mesenteric cyst. Surgery was successfully performed under segmental epidural anesthesia. The pre-operative problems and peri-operative management is discussed. We suggest that epidural anesthesia can be used for successfully managing similar patients. Support was provided solely from institutional and departmental sources. The authors have obtained Institutional Review Board approval and informed written consent from the patient for publishing the details of her treatment.