A morbidly obese 44-year-old man, weighing 100 kg and 172 cm tall, was admitted to our hospital with severe burn. Forty-seven % of the total body surface area and respiratory tract were injured. Burn index was estimated to be 37. In the emergency room, his trachea was urgently intubated without muscle relaxant and sedatives to manage difficult airway from morbid obesity and airway burn. Pressure support ventilation was started using a ventilator, SAVINA (Dräger, Germany). Simultaneously, sivelestat sodium hydrate was administered for acute lung injury (ALI). On day 3, early skin grafting under general anesthesia was scheduled. The ICU ventilator, SAVINA, was used continuously during anesthesia because his respiratory management had been successful with SAVINA. Total intravenous anesthesia (TIVA) was performed using propofol, fentanyl and vecuronium. To avoid high airway pressure and improve arterial oxygenation, he was positioned at reverse-Trendelenburg's position during anesthesia. Anesthesia and the post-operative course was uneventful.