Life-Threatening Suspected Intraoperative Bronchospasm During Tracheostomy in a Morbidly Obese Patient: A Case Report.

Suspected severe intraoperative bronchospasm presenting with a silent chest and ventilation failure is a life-threatening emergency. We present a case of a morbidly obese patient (body mass index (BMI) 49.3 kg/m²) who developed suspected severe bronchospasm accompanied by profound hypotension during tracheostomy following prolonged endotracheal intubation and was successfully managed with immediate intervention. This case highlights the importance of rapidly differentiating mechanical airway obstruction, perioperative anaphylaxis, and bronchospasm in severe ventilatory failure. Early recognition and prompt administration of intravenous (IV) epinephrine, along with proactive airway management, are critical in high-risk patients.