Perioperative Nursing Interventions for a Morbidly Obese Patient Undergoing a Cesarean Section in the Ramp Position:...

This case report describes a multidisciplinary perioperative nursing intervention for a morbidly obese woman in her 30s (BMI 50.9) undergoing elective cesarean section. The patient had severe obstructive sleep apnea and orthopnea, making the conventional supine position unsafe. A preoperative simulation involving obstetricians, anesthesiologists, surgical nurses, and clinical engineers was conducted to evaluate the feasibility of performing the surgery in the ramp position. The team also prepared emergency response protocols using a photo-based manual and preassembled equipment. During surgery, the patient was successfully positioned in the ramp position and underwent spinal anesthesia. Due to inadequate pain control, sedation was initiated, which led to respiratory depression requiring bilevel positive airway pressure (BiPAP) support. No intraoperative or postoperative complications, such as pressure injuries or nerve damage, were observed. The patient reported no psychological distress related to the positioning or simulation. This case highlights the importance of simulation-based planning and interprofessional collaboration in ensuring surgical safety for high-risk patients. Surgical nurses played a central role in coordinating the simulation and intraoperative care, emphasizing their contribution to perioperative team performance. This report offers a practical model for managing complex obstetric cases involving morbid obesity through nursing-led simulation and tailored patient-centered care.