Intubating Morbidly Obese Patients: Position Matters

Morbidly obese patients are more difficult to intubate or ventilate with a bag and mask and desaturate more rapidly than nonobese patients — a troubling combination — but whether or not morbid obesity itself makes intubation more difficult remains controversial (JW Emerg Med May 29 2002 and Anesth Analg 2003; 97:595). Head elevation has been shown to make intubation easier in obese patients, and experts recommend special positioning to raise the patient’s head anterior to the shoulders and to align the external auditory meatus with the sternal notch or angle.

Researchers block-randomized 85 obese patients (body-mass index [BMI], >30 kg/m²) who were undergoing elective surgery and did not have histories of difficult intubation to be positione…