Morbid Obesity and the Airway

Morbid Obesity and the Airway Chris Davis – T3

Obesity • BMI > 30 = Obese, >40 = Morbid Obesity • Louisiana: 31.0% of adults are obese • 5th in the nation, MS = 34.0% • Orleans Parish – 29.9% • Terrebonne – 38.9%

Cardiovascular and Respiratory Function • Obesity causes a proportional increase in circulating blood volume, plasma volume and cardiac output. • For each kg of adipose tissue, CO increases by .1L/min • Moderate HTN is present in around 50% of obese individuals • Obesity causes proportional increases in O2 consumption and CO2 production. • Both expiratory reserve volume and functional residual capacity are reduced in obese patients

Obesity’s Effects on the Airway • Increased work of breathing due to abnormal chest wall elasticity and an elevated diaphragm • Shallow, rapid breaths • Limited ventilatory capacity • Increased fat deposition in pharyngeal tissues increases likelihood of pharyngeal wall collapse • Reduced neck mobility • Desaturation time is greatly decreased in the obese

Preoxygenation • Administer the highest possible concentration of oxygen with a bag-valve mask • Place the patient in an upright position whenever possible • Oxygen reserves can be maximized by administering high-flow oxygen for 3 – 5 minutes while the patient breathes normal tidal volumes

Morbid Obesity and the Airway