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Evidence-based Practice and Quality Improvement

Self-positioning following awake fiberoptic intubation is a safe and well-tolerated procedure for positioning of the morbid obese patient in the prone position


Rovsing, M. L.; Skovgaard, Olsen K.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 20-20
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Background and Goal of Study: Positioning of anaesthetized morbidly obese patients in the prone position is labor intensive and may be complicated by injuries to soft tissue, and nerves (1).

Therefore we decided to perform awake fiberoptic tracheal intubations in a series of obese patients who afterwards positioned themselves in the prone position and to register complications associated with the placement on the operating table.

Materials and Methods: Thirteen consecutive patients scheduled for spine surgery, BMI >40 and/or weight >130 kg, were included. Under light sedation (remifentanil 2-5 m/kg/h and 1-2 mg of midazolam i.v) the patients were topical anaesthetized with 1% lidocaine in the pharyngeal cavity, 2% at the base of the tongue, and 4% on the vocal cords and intratracheally. Fiberoptic tracheal intubation was performed and afterwards the patients settled themselves in a comfortable prone position on the operating table where after general anaesthesia was induced. Data on sore throat, hoarseness, pain in neck or shoulders, nerve injuries, and acceptance of the procedure were registered 3and 24 hours postoperatively.

Results and Discussion: Five women and 8 men aged 21-65 years where included. Median weight was 130 kg (range 106-171) and median BMI 43 (range 35-55). Median duration of surgery was 110 minutes (range 40-225). All patients tolerated topicalization and the intubation well. Their only complaint was to the taste of the local anaesthesia. No patient had paraesthesia after the surgery. Three hours postoperatively 5 patients had light pain localized to the shoulders (VAS 1-3). Two of these patients scored 1 the following day. Two patients suffered from light neck pain (VAS 1) at three hours and on the day after. Three patients suffered from sore throat at 3 hours (VAS 1-3) and 2 (VAS 1) on the day after the surgery.All patients stated that they would not hesitate to go through the same procedure another time.

Conclusion(s): Awake fiberoptic intubation of obese patients followed by selfpositioning in the prone position seems to be a safe and well tolerated procedure wich might reduce pain from nerves, muscles, and joints after surgery. In addition this method saves manpower.


1. Brodsky JB. Positioning the Morbidly Obese Patient for Anesthesia. Obesity Surgery 2002; 12: 751-758.
© 2013 European Society of Anaesthesiology