Airway Management inthe Obese Patient

Obesity is a serious disorder and an increasing problem all over the world. During the past several decades, the worldwide prevalence of obesity has steadily risen, with the greatest increase occurring in the United States. The incidence of obesity has doubled in adults and tripled in children in the United States over the past 30 years; more than 60 million adults and 9 million children aged 6 to 19 years are obese or overweight. Furthermore, the prevalence of extreme obesity (body mass index [BMI] >40) has seen the greatest growth this past decade. This increase was seen in both sexes, all racial/ethnic groups, all age groups, and all education levels. With such global epidemic, the presentation of an acutely ill or injured morbidly obese patient is currently a common occurrence. Obese patients may present also for an elective procedure, for bariatric surgery, or for obstetric anesthesia or analgesia. Expertise in airway management becomes an important skill for any health care provider involved in the care of these patients. The main body of this review will discuss strategies for airway assessment before intubation, controversies surrounding airway management, and approach to safe extubation in this population. The article will also address the role of noninvasive ventilation in the management of obese patients (other than sleep apnea) and practiced techniques for temporary tracheostomy placement in critically ill obese patients.