12 - Airway management

Summary

Reports of anesthesia-related deaths in obstetric practice point to difficulties with airway management in morbid obesity (MO) parturients as the primary cause. A large proportion of patients recruited for airway studies in MO are recruited from bariatric surgical populations, which typically exhibit a large preponderance of female patients. Numerous anatomic factors contribute to difficult airway management in the MO patient. This chapter presents options for airways management in an order that reflects their application in the American Society of Anesthesiologists (ASA) Difficult Airway Algorithm. Awake intubation maintains airway patency and spontaneous respiration, but is not without hazard in this difficult patient group. Flexible fiberoptic laryngoscopy is the most common technique chosen for awake intubation, but visualization may be difficult when excess fat deposition results in airway narrowing and redundant folds of tissue. Equal care and equipment should be available for extubation as well as intubation.