Anesthetic Management of Extreme Obesity: A Case Study

Obesity and Autism Spectrum Disorder (ASD) are prevalent conditions that significantly impact anesthetic management due to airway challenges, metabolic risks, and behavioral considerations. Obesity affects 42% of U.S. adults, while ASD prevalence in adults is approximately 2.21%, necessitating tailored perioperative care strategies. We describe the anesthetic management of a 30-year-old male with a BMI of 101.1, weighing 707 lb (320.7 kg), measuring 5'9" (1.75 m) and ASD undergoing dental surgery. Preoperative challenges included obesity-related airway risks and communication barriers due to ASD. Despite preoperative preparation, the patient was uncooperative, requiring anesthesia induction on a transport cart. General anesthesia was administered using a rapid-sequence intubation technique with succinylcholine, and airway management was facilitated with ramp positioning. Intraoperative care included sevoflurane, along with adjunctive infusions of propofol, dexmedetomidine, and boluses of fentanyl. Postoperative recovery was uneventful, with stable vitals and effective pain management. Patients with both obesity and ASD present unique anesthetic challenges, including increased airway management risks and behavioral sensitivities. Effective strategies include individualized preoperative preparation, the use of anxiolytics like midazolam, and vigilant intraoperative monitoring. Postoperative care requires careful pain assessment, as individuals with ASD may express discomfort atypically. This case highlights the importance of interdisciplinary collaboration and adherence to obesity-specific perioperative guidelines to optimize outcomes. Further research is needed to establish tailored guidelines for managing individuals with extreme obesity and ASD undergoing surgical procedures.