[Airway management in the morbidly obese patient].

Obesity has become a "global pandemic" in the modern world. One of the anesthetic challenges associated with obesity is securing the patients' airway. It is well known that obese patients have a higher complication rate during anesthesia as compared to patients with normal weight, but the reasons for this are controversial. Although obesity in itself does not pose a problem during anesthesia, several types of obesity, specifically the central (abdominal, visceral, android or apple-shaped) obesity, the type which is often called "inflated bear" type, cause more difficulty in maintaining open airways during the various stages of anesthesia, particularly during induction. In this review, we describe the specific reasons for difficulty in securing the airway in the obese patient population. We present the complications and the typical problems that the anesthesiologist may encounter in each stage of anesthesia and suggest ways to solve them.

Cough, expiration and aspiration reflexes: possible anesthetic implications - a brief review.

Systematic study in animals indicated, that in addition to cough there are 2 distinct airway reflexes. The aspiration reflex (AspR) characterized by rapid and strong gasp-like inspiration provoked by stimulation of nasopharynx, nasal phyltrum or auricle of ear. The expiration reflex (ExpR) manifests by prompt expiration, induced by laryngeal stimulation. Both reflexes strongly activate the brainstem inspiratory or expiratory generators, respectively, and inhibit the opposite respiratory and various functional disorders. This paper indicates several functional disorders occurring during manipulation with airways in anaesthesiological practice, which can be influenced positively or negatively by application of these special reflexes (asphyxia, breath-holding, laryngospasm, bronchospasm, sleep apnoea episodes, arrhythmia, collapse, etc.). The AspR, ExpR and CR (cough reflex) have important clinical relevance in anaesthesia and emergency medicine applicable also in domestic therapy and in hardly accessible places particularly by application of ICT (Information & Communication Technologies) using a mobile connection of the patient with the remote hospital centre.