Positioning for Intubation in Morbidly Obese Patients : Anesthesia & Analgesia

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Letters to the Editor: Letters & Announcements

Positioning for Intubation in Morbidly Obese Patients

Zvara, David A. MD; Calicott, Randy W. MD; Whelan, Deborah M. MD

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Anesthesia & Analgesia 102(5):p 1592, May 2006. | DOI: 10.1213/01.ANE.0000215164.12793.CD
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To the Editor:

Patient positioning in the obese patient is of critical importance when performing laryngoscopy. Brodsky et al. (1) report a series of 100 patients in which 99 were successfully tracheally intubated using an elevated head-up position (Fig. 1) (2). In this position, the shoulders are elevated with several pads, the head and neck are extended, and the external auditory meatus is in line with the sternal notch. We propose a modification of this position that achieves the same goals without application of the rolls under the patient's shoulders (Fig. 2). This modified position is commonly used in our hospital. Our positioning technique achieves the same relative patient orientation without the burden of placing the extra pads under the shoulders. This positioning is effective and saves the health care provider from the additional strain of moving the weight of these large patients.

Figure 1.:
Elevated head-up position. Reproduced with permission from Airway Cam Video Series, Volume 3: Advanced Airway Imaging and Laryngoscopy Techniques. Courtesy of Richard Levitan, MD, Airway Cam Technologies, Inc., Wayne, PA.
Figure 2.:
Whelan-Calicott position.

David A. Zvara, MD

Randy W. Calicott, MD

Deborah M. Whelan, MD

Department of Anesthesiology

Wake Forest University School of Medicine

Winston-Salem, NC

[email protected]


1. Brodsky JB, Lemmens HJM, Brock-Utne JG, et al. Morbid obesity and tracheal intubation. Anesth Analg 2002;94:732–6.
2. Brodsky JB, Lemmens HJ, Brock-Utne JG, et al. Anesthetic considerations for bariatric surgery: proper positioning is important for laryngoscopy. Anesth Analg 2003;96:1841a–2a.
© 2006 International Anethesia Research Society