a laryngeal mask airway along with a general anesthetic. Says Dr.
Dutton, "It's quite possible that in a few years we'll look at [obese
patients] and say, 'We can do this with some sedation and be reason-
ably confident the patient will stay saturated on high-flow oxygen.'"
One important caveat: High-flow oxygen increases fire risk.
Dr. Berkow says these devices address a vital safety issue for ambu-
latory facilities: patients with severe sleep apnea who require CPAP.
"Being able to better oxygenate them immediately upon extubation
may shorten their throughput through the recovery room in an outpa-
tient environment," she says.
Dr. Losasso believes we don't yet have the tools to definitively deter-
mine how big a risk a particular high-BMI patient may be. While you
likely have a magic BMI cutoff, "BMI by itself is not necessarily indica-
tive of the ability to care for [patients] effectively," says Dr. Losasso,
who points to football players whose BMIs are high due to muscle
rather than fat. "The question is, what's the magic metric that's more
specific than BMI that indicates an airway problem?"
Flexible nasopharyngoscopy
The ability to assess a patient's airway before surgery continues to
develop. "We sometimes forget what almost all the difficult airway
algorithms focus on, the first step — assessing your patient and mak-
ing an airway plan," says Dr. Berkow.
But although pre-op assessment is vital, it's not always performed.
"Anecdotally, when you hear about things that don't go well, some-
times you'll hear, 'Oh, I have a video laryngoscope, I'll be fine,'" says
Dr. Berkow. "But what if your video laryngoscope doesn't succeed?
What's your plan B, and are you immediately ready to perform it?
Having a backup plan is really important, because if you can't oxy-
genate and ventilate your patient, it doesn't matter which device you
picked — if it didn't work, you still have a problem if you don't have a
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