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Chapter: Clinical Cases in Anesthesia : Morbid Obesity

Is MO an indication for awake intubation?

Neither absolute body weight nor absolute BMI are independent indicators for awake intubation.

Is MO an indication for awake intubation?

 

Neither absolute body weight nor absolute BMI are independent indicators for awake intubation. The vast majority of MO patients undergo rapid sequence induction with cricoid pressure. Obesity is a recognized predictor of difficult mask ventilation, so another supraglottic airway device may be needed to provide oxygenation if intubation fails. Typically, laryngeal mask airways (LMAs) are used for this purpose, but any one of a number of alternatives is a reasonable choice. The ProSeal LMA offers certain advan-tages over other devices. It could divert regurgitated gastric contents away from the larynx and provides the potential for passing a gastric tube into the stomach. LMAs and other supraglottic airway devices remain relatively con-traindicated for elective use in MO patients, but are accept-able choices for emergency use.

 

The need for awake intubation is determined by the airway examination. When traditional predictors of diffi-cult intubation exist, awake intubation may be a good alternative. Occasionally, a patient’s neck may be so fat that thyromental distance, hyomental distance, and sternomen-tal distance cannot be assessed. In such cases, this author prefers flexible fiberoptic intubation with the patient awake and spontaneously breathing.

 

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Clinical Cases in Anesthesia : Morbid Obesity : Is MO an indication for awake intubation? |


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