Anesthesia Management of a Morbidly Obese Patient in a Nonbariatric Setup Using HFNO: A Case Report

On preanesthetic evaluation, the patient had been hypertensive for 20 years and was on a combination of telmisartan and hydrochlorothiazide.She gave a history of snoring, although she had not been evaluated further for OSA.She was on thyroxine (25 µg) tablet for hypothyroidism for 15 years and was euthyroid.She gave a history of being investigated for lower backache a few years prior, and radioimaging had shown degenerative changes in D11-12, L3-4, and L5-S1.However, she was on conservative management for it.On examination, her pulse rate was 96/minute regular, and BP was 140/90 mm Hg as measured on the upper limb IntroductIonAnesthesia management in obesity is challenging due to associated comorbidities like hypertension, dyslipidemia, ischemic heart disease, diabetes mellitus, osteoarthritis, liver disease, asthma, obstructive sleep apnea (OSA), and obesityhypoventilation syndrome.1 Obese patients may experience perioperative hypoxemia due to reduced functional residual capacity (FRC) and increased oxygen demand, emphasizing the importance of appropriate oxygenation in improving patient safety. 2 High-flow nasal oxygenation (HFNO) is a relatively newer technique of oxygenation with rapidly increasing applications.3 It delivers high fraction of inspired oxygen (FiO 2 ) compared to conventional oxygen delivery systems, with a flow rate of up to 70 L/minute, which matches or even exceeds patients' peak inspiratory flow rate. 2 We describe the management of a morbidly obese patient for dilation and curettage (D&C) hysteroscopy in a nonbariatric setup to highlight the effective usage of HFNO and various other challenges faced by us. case descrIptIonA 66-year-old female, weighing 160 kg, 150 cm in height, body mass index (BMI) 71.1 kg/m 2 , with morbid obesity, came with complaints of post-menopausal bleeding.She was posted for hysteroscopy with dilatation and curettage.