Recently, the team led by Du Hailiang from the Department of Anesthesiology at the Qinghai Hospital of the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU), in collaboration with the team led by Li Yu from the Department of General Surgery, successfully performed a highly challenging laparoscopic sleeve gastrectomy for a severely obese patient weighing 198 kg. With advanced diagnosis and treatment techniques and multidisciplinary collaboration, the teams overcame multiple surgical challenges.
The patient, a 53-year-old male, had morbid obesity and multiple severe comorbidities, including severe fatty liver, severe obstructive sleep apnea hypopnea syndrome, severe hypoxemia, grade 3 hypertension, and insulin resistance, resulting in extremely high anesthesia and surgical risks. In particular, severe sleep-related respiratory problems and hypoxemia made airway management and anesthesia regulation the greatest challenges.
In response to the difficulties commonly seen in severely obese patients, such as difficult airway management, marked respiratory and circulatory fluctuations, special metabolism of anesthetic drugs, and a high risk of perioperative complications, the anesthesiology team conducted precise preoperative assessment and developed an individualized perioperative anesthesia plan. A full set of emergency equipment for difficult airway management, such as a video laryngoscope and fiberoptic bronchoscope, was prepared. Instead of following the conventional practice of dosing based on total body weight, the team accurately calculated anesthetic doses according to lean body weight and adjusted body weight, enabling refined medication control.
When the patient entered the operating room, his initial oxygen saturation was only 75%, which increased to 97% after professional preoxygenation. During anesthesia induction, the team overcame critical situations such as high resistance to mask ventilation, a sudden drop in oxygen saturation, and difficult tracheal intubation, and rapidly completed tracheal intubation with skilled techniques. During the operation, a lung-protective ventilation strategy was adopted, vital signs were monitored in real time, anesthetic dosage was dynamically fine-tuned, and the patient’s condition remained stable throughout the procedure.
The operation lasted five hours and proceeded smoothly and steadily throughout. After surgery, the patient was safely transferred to the ICU for monitoring and was successfully transferred back to the general ward the following day.
The success of this extremely challenging bariatric surgery not only demonstrates the superb minimally invasive surgical skills of the Department of General Surgery, but also highlights the strong professional capabilities of the anesthesiology team in airway management, precision anesthesia, and life monitoring for critically ill obese patients. It also reflects the hospital’s high-level medical expertise in multidisciplinary collaborative treatment of complex, difficult, and critically ill patients.
