Airway situation
Morbid obesity / OSA / difficult preoxygenation
Type: Medical
Before
- Ramp to ear-to-sternal-notch; head-up positioning.
- Use PEEP/NIV/HFNC strategy as appropriate; desaturation occurs quickly.
- Stage longer equipment/redundant oxygenation/rescue plan.
During
- Maintain apneic oxygenation if possible.
- Optimize view with position and external laryngeal manipulation.
- Be ready for two-hand BVM, adjuncts, and SGA rescue.
After
- Use appropriate PEEP, recruitment strategy, and sedation.
- Confirm tube depth carefully; habitus can mislead.
- Plan safe transport with oxygen reserve.
Pitfalls
- Flat positioning.
- No PEEP during preoxygenation.
- Assuming “large patient” only changes ETT size.