With the growing Obesity epidemic in America, anesthetists are continually facing the risk of induction and intubation with a potentially difficult airway. Many theories are in the literature about the “best” technique for safe induction of the morbidly obese patient. Pre-oxygenation is essential and proper positioning increases the odds of successful airway management.
A recent article by Toso et al. published in the European Journal of Anesthesiology (Eur J Anaesthesiol. 2011 Nov;28(11):781-7. described adding a component of inhalation anesthesia to the rapid sequence induction technique for morbidly obese patients. In this study, the authors positioned and pre-oxygenated patients. When ready for induction, the researchers turned on Sevoflurane and after 30 seconds of breathing the agent, they followed with a rapid sequence induction using propofol, alfentanil and Succinylcholine. All patients were easily intubated on the first attempt and there were not occasions of desaturation.
The authors demonstrated that adding Sevoflurane to the RSI sequence provided conditions for a safe and controlled induction of anesthesia.
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