According to an article published by the Journal of Emergency Medical Services (JEMS), the challenges of emergency airway management in morbidly obese patients can be overcome with proper preparation, body positioning, and other important steps.
“Between 13–35% of intubations in the bariatric surgery setting have been difficult or required the use of difficult airway adjuncts, and is probably higher in the prehospital setting,” write Douglas R. Dixon, MD, and Darren Braude, MD, MPH, FACEP, EMT-P, of the University of New Mexico School of Medicine.
“In airway procedures, preparation is 90% of success. For obese patients, positioning is 90% of this preparation. Other considerations include utilizing NIPPV and nasal cannula apneic oxygenation, utilizing multiple providers and airway adjuncts for BVM ventilation, correctly dosing medications based upon ideal, lean or total body weight, and having backup airway devices ready,” they conclude.
Bariatric Airway Management Is about More than Intubation
I’ve found that if I elevate the head of the bed at least 45 degrees I’m able to have a much better view of the airway.
Gravity helps pull the neck tissues down instead of having to lift it with the laryngoscope.
If the head of the bed is elevated at least 45 degress gravity will help you achieve a much better view of the airway.