Airway management and oxygenation in obese patients

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

“…8 Compared with nonobese patients, obese patients have an increased tongue size, a smaller pharyngeal area, redundant pharyngeal tissue, an increased neck circumference, and an increased chest girth. [9][10][11] These changes are associated with obstructive sleep apnea, obesity hypoventilation syndrome, and respiratory failure. [9][10][11] Increased abdominal girth reduces diaphragmatic expansion, resulting in hypoventilation and a reduction in total lung capacity and functional residual capacity.…”

“…[9][10][11] These changes are associated with obstructive sleep apnea, obesity hypoventilation syndrome, and respiratory failure. [9][10][11] Increased abdominal girth reduces diaphragmatic expansion, resulting in hypoventilation and a reduction in total lung capacity and functional residual capacity. As a result, morbidly obese patients tend to have higher rates of respiratory failure and subsequent intubation.…”

“…[9][10][11] The recommended method for bag-mask ventilation and oxygenation before intubation in morbidly obese patients is to place the patient in a 25º head-up position or reverse Trendelenburg position to shift the weight of the chest wall inferiorly and improve diaphragmatic excursion. 10,12 The head-up or "ramped" position is achieved by horizontally aligning the sternal notch with the external auditory meatus. The position can be accomplished by using multiple folded blankets under the upper part of the body, shoulders, or head.…”

Definitive airway management of patients presenting with a pre-hospital inserted King LT(S)-D™ laryngeal tube airway: a historical cohort study

“…7,8 In addition, other factors in this patient population may further complicate airway management, including edema from multiple or traumatic intubation attempts, 9 facial trauma, 9 massive fluid resuscitation, and patient-related factors such as obesity. 10 Because the pre-hospital use of the King LT by EMS personnel is relatively new, anesthesiologists may be unfamiliar with the device and with the effectiveness of available techniques to perform tube exchanges. As anesthesiologists may be called to evaluate and exchange this device for an ETT under urgent or emergent conditions, understanding the complications associated with the use of the device and the techniques for safely performing a device exchange may be life-saving.…”

Fast wake-up time in obese patients: Which anesthetic is best?

“…3 Furthermore, obese patients are prone to intraoperative pulmonary complications 4 and acute upper airway obstruction and aspiration following tracheal extubation at the end of surgery. 5 Obese patients have a higher incidence of sleep apnea and develop hypoxia during the early postoperative period. 6 A faster recovery from anesthesia may decrease these risks by reducing the time patients require to resume control of their spontaneous breathing, restore airway protective reflexes, and regain efficient coughing.…”