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