Perioperative management of an obese patient complicated with Sleep Apnea Syndrome (SAS) undergoing awake craniotomy

Noriaki Komayama, Kotoe Kamata, Takashi Maruyama, Masayuki Nitta, Yoshihiro Muragaki, Makoto Ozaki

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Both obesity (BMI over 30) and SAS are risks for upper airway maintenance. We report an obese patient (BMI 33.5) with SAS who underwent awake craniotomy. Weight reduction was instructed 1 month before the operation, and the patient lost enough weight to use intraoperative MRI. Under general anesthesia, surgical pads containing 2% lidocaine with adrenaline were inserted into the nasal cavities. The patient's airway was secured by i-gel® until dura was opened. A nasal airway was then inserted to confirm the upper airway patency and anesthetics were terminated. The patient regained consciousness and started respiration. The i-gel® was removed. The nasal airway was changed to an RAE tracheal tube ; the tube was fixed above the vocal cords under bronchofiberscopic observation. Continuous positive airway pressure (CPAP) via RAE tube was started. Neither coughing nor epistaxis was observed. The RAE tube prevented giossoptosis and did not disturb speech mapping. Emergent endotracheal intubation was easily managed because the tube was close to the glottis. The RAE tube was removed and nasal CPAP was applied overnight Carefully prepared CPAP support via nasal RAE tube was practical in keeping upper airway patency for an obese patient complicated with SAS undergoing awake craniotomy.

Original languageEnglish
Pages (from-to)1117-1121
Number of pages5
JournalJapanese Journal of Anesthesiology
Issue number10
Publication statusPublished - 2014 Oct 1
Externally publishedYes


  • Anesthetic risk
  • Awake craniotomy
  • Intraoperative Mri
  • Obesity
  • Sleep apnea syndrome

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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