Difficult airway management

Difficult airway management in the morbidly obese population is an important topic as the physiological changes of obesity can lead to grave consequences when oxygenation is not rapidly established following anaesthetic induction. The correlation between elevated body mass index and direct laryngoscopy is unclear, probably because excess adipose tissue has a variable distribution among morbidly obese patients. The reader will be able to identify the subset of morbidly obese patients where difficult airway management is indeed expected. In such patients, optimizing modifiable factors such as preoxygenation, apnoeic oxygenation, positioning, and minimizing atelectasis is of primary importance. Alternative strategies for tracheal intubation other than direct laryngoscopy are discussed in this chapter, as well as safe extubation strategies for the difficult airway.