| Summary: | During general anesthesia, anesthesiologists encounter problems including difficult airway intubation, high respiratory airway pressure, fluctuation of blood pressure, and poor oxygen saturation, especially in obese patients. In addition, obese patients with asthma or bronchospasm make these difficulties even more challenging. We present the case of a 37-year-old male with morbid obesity (height: 160 cm, weight: 120 kg, and body mass index: 47 kg/m[2]) with asthma attack and who was injured during a car accident that caused open fracture of the right patella which needed emergent open reduction and internal fixation surgery. He refused spinal anesthesia. By using rocuronium and its reversal agents sugammadex, lidocaine, β-2 agonist, epinephrine, sevoflurane, hydrocortisone, magnesium sulfate, and deep extubation, we were able to intubate smoothly and extubate successfully after the surgery without intensive care.
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