• Paola Aceto, Valter Perilli, Cristina Modesti, Pierpaolo Ciocchetti, Francesca Vitale, and Liliana Sollazzi.
• Department of Anesthesiology and Intensive Care, A. Gemelli Hospital, Largo A. Gemelli, 8, 00168 Rome, Italy. Electronic address: pa.aceto@gmail.com.
• Surg Obes Relat Dis. 2013 Sep 1;9(5):809-15.

AbstractThe well-known difficulties in airway management in obese patients are caused by obesity-related airways and respiratory changes. Anesthesiologists confront a number of troubles, including rapid oxygen desaturation, difficulty with laryngoscopy/intubation and mask ventilation, and increased susceptibility to the respiratory depressant effects of anesthetic drugs. Preoperative assessment of the airways in the obese should include examination of specific predictors of difficult mask ventilation other than those for difficult intubation. Difficulties in airway management are decreased after providing optimal preoxygenation and positioning ("ramped"). Other strategies may include availability of alternative airway management devices, including new video laryngoscopes that significantly improve the visualization of the larynx and thereby facilitate intubation. If awake intubation is mandatory, it may be performed with fibrobronchoscope after providing an adequate topical anesthesia and sedation with short-acting drugs, such as remifentanil. Succinylcholine for rapid sequence induction might be replaced by rocuronium where sugammadex is available for reversal. A complete reversal of neuromuscular block, measured by train-of-four monitoring, should be obtained before extubation, which requires a fully awake patient in the same position with airway equipment used for intubation.© 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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