One-third of American adults are obese. Due diligence and proper screening are the keys to preventing problems. While difficult airways are common in obese patients, BMI shouldn’t be the lone determining factor when deciding whether to treat them. There are other considerations which are just as important including a patient’s Mallampati score and neck circumference. A Mallampati score of 3 or 4 may indicate potential difficulty or a neck circumference of more than 40 cm. And as circumference increases, so does the risk. Additionally, a thyromental distance (the distance between the thyroid notch and the mentum) of less than 6 cm suggests potential difficulty. The incidence of difficult intubation in obese patients has been reported to be between 13% and 24. Obese patients also often have tough-to-access veins. You must establish an adequate line before the patient reaches the OR. Otherwise, administering emergency drugs becomes a challenge. Calculate the medications and dosages you’ll need to ensure a successful recovery without compounding respiratory issues that are already likely to be present.
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