Airway management in patients suffering from morbid obesity.

Obesity is no longer a disease of the affluent. The prevalence of obesity has risen at an exponential rate globally, with an increasing burden on healthcare resources. Perioperative management of patients with morbid obesity is known to be challenging, and this is particularly so in the management of their airway, a crucial procedure that requires meticulous planning and modifications. Anesthesiologists will expect to see more patients with obesity in their practice presenting for both bariatric and non-bariatric surgery, or even for emergency surgery. Hence, any generalist anesthesiologist should be confident in managing such a patient, with the appreciation that these patients often pose a significant challenge to the practice of anesthesia. This article describes different techniques and looks at the evidence for airway management in the morbidly obese. Other aspects of perioperative management of such patients are beyond the scope of this article.

Enhanced Experiential Learning in Airway Management: Surgical Modification of Cadavers.

INTRODUCTION: Failure of airway management remains a significant source of morbidity and mortality. Advanced airway management has been addressed effectively by simulation-based training. However, simulation of difficult airways in manikins is limited by the pre-set conditions provided by the manufacturer. Life-like conditions in the form of the softness of the tissue and true anatomy as seen in cadaver models are needed to create simulated models with a closer resemblance to real patients. The goal of this study was to determine the feasibility of simulating difficult airway from submandibular abscess in cadaver models by surgical modification of the cadaver heads for use in enhanced experiential learning of the management of difficult airways. METHODS: The cadaver heads were modified surgically to simulate a submandibular abscess. The models were used in an airway course where participants provided feedback on the realistic nature of the model and its benefits for difficult airway training. The ease of tracheal intubation of the models with the assistance of video laryngoscopy was assessed. RESULTS: The modified cadavers were acceptable in simulating difficult airway as demonstrated by the feedback from the participants. All participants (100% [95% confidence interval = 89.1%-100%]) found the models to be realistic and beneficial for difficult airway training. A good proportion (56.3%) felt that the intubation technique was made easier with the video laryngoscopy. CONCLUSIONS: Cadavers can be modified to simulate pathologies associated with difficult airways. These models can be used to enhance experiential learning and the management of difficult airways.