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Cohort 174 patients ; had BMIs greater than 40, and they were compared with a cohort of normal-weight patients. Members of the medical team routinely built a ramp with blankets to optimize head and neck position and to improve the thoracic-cervical spine relationship. The groups differed significantly in Mallampati class, which relates tongue size to pharyngeal size. A total of 90% of the normal-weight patients were Mallampati class 1 or 2, compared with 16% of MO patients. Fully 42% of MO patients were Mallampati class 4, compared with 2.6% of nonobese patients. Mild hypoxemia was found in 33% of the MO group, significantly greater than the 17% of the normal-weight patients. Likewise, severe hypoxemia was more common in MO patients 11% vs. 2% ; . No significant differences were noted in the rates of esophageal intubation or regurgitation. Dr. Mort attributed this to the more frequent use of accessory devices in the morbidly obese. s Dr. Susan M. Harding, FCCP, comments: Although this is a retrospective study, it shows that morbidly obese individuals BMI of greater than 40 kg m2 ; are more likely to require multiple intubation attempts and accessory airway device use for successful intubation. With the increased prevalence of obesity in our society, we need to ensure that intubation kits in our practicing hospitals have accessory airway devices, including bougies and laryngeal mask airways.
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