inducing morbid obese

[sevoflurane]

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That is why I'm in the other camp. For me, it's simple with these plump patients:

1. RSI (not a MRSI) +/- glidescope in the room
2. Awake or SV FOI

Reverse T, FRC full of O2, good positioning, induce, tube.

 

[SouthSideSteve]

Then again, I'm no doctor, I'm just a scrub.

-CJ

thanks for adding that. we would have never known you weren't an actual medical professional from your post.

 

[epidural man]

What does the literature say on the topic?

Apparently not much.

Here is a survey article that is a useful read. (link is just the abstract)
http://bja.oxfordjournals.org/content/104/3/313.abstract

Also, it is pretty clear that using NMB improves intubating success.
http://bja.oxfordjournals.org/content/103/2/283.abstract

If you get in a situation where you need to get the patient back to spontaneous breathing after propofol, don't forget that doxepram as a respiratory stimulant can help you a ton - (essentially will bring the patient back to spontaneously breathing)

 

[CecilJacobson]

...Definitely need to stay out of the deep end of SDN, especially as a new pre-med member, even as a non-trad. Also, didn't realize that I was posting in the MD/DO (specifically the Anesthesiology) forum.

I don't mind the lambasting, and I'm pretentious enough to appreciate witty mockery. Probably also should have realized that nobody here was talking about not using an LMA. Definitely should have spent more time reading the original post than responding.

👎

 

[BobBarker]

On your awake FOI's do you guys ever use Precedex? I'm just a floor intubation jockey at this point in my career. For the morbidly obese on the floor as a PGY1 with no SR/Attending support.
1. First, transfer to ICU prior to intubation if possible.
2. Glidescope in room
3. Reverse Tberg, optimize Pt's positioning for me, usually raise the bed quite a bit.
4. Mac 4, it helps push the pt's redundant tissues away
5. 20mg Etomidate, 4mg Versed. Pt is usually still spontaneously breathing, sometimes not. We were out of propofol until recently. I figured out why I give the Versed other than it being a seemingly institutional standard. Gives you a much better cushion during transport, hooking up the vent, etc for pt compliance. Last time I ordered a Versed drip, it took 30 minutes or so to arrive after the order was entered and I had to bolus some more Versed.
6. Only had to give Sux once, Pt was clamped down. Little person, though.

Success so far.

 

[OB1🤙]

On your awake FOI's do you guys ever use Precedex? I'm just a floor intubation jockey at this point in my career. For the morbidly obese on the floor as a PGY1 with no SR/Attending support.
1. First, transfer to ICU prior to intubation if possible.
2. Glidescope in room
3. Reverse Tberg, optimize Pt's positioning for me, usually raise the bed quite a bit.
4. Mac 4, it helps push the pt's redundant tissues away
5. 20mg Etomidate, 4mg Versed. Pt is usually still spontaneously breathing, sometimes not. We were out of propofol until recently. I figured out why I give the Versed other than it being a seemingly institutional standard. Gives you a much better cushion during transport, hooking up the vent, etc for pt compliance. Last time I ordered a Versed drip, it took 30 minutes or so to arrive after the order was entered and I had to bolus some more Versed.
6. Only had to give Sux once, Pt was clamped down. Little person, though.

Success so far.

I would subsititute ketamine for etomidate in this situation, if maintaining spontaneous ventilation is your goal.

 

[lord_jeebus]

On your awake FOI's do you guys ever use Precedex? I'm just a floor intubation jockey at this point in my career. For the morbidly obese on the floor as a PGY1 with no SR/Attending support.
1. First, transfer to ICU prior to intubation if possible.
2. Glidescope in room
3. Reverse Tberg, optimize Pt's positioning for me, usually raise the bed quite a bit.
4. Mac 4, it helps push the pt's redundant tissues away
5. 20mg Etomidate, 4mg Versed. Pt is usually still spontaneously breathing, sometimes not. We were out of propofol until recently. I figured out why I give the Versed other than it being a seemingly institutional standard. Gives you a much better cushion during transport, hooking up the vent, etc for pt compliance. Last time I ordered a Versed drip, it took 30 minutes or so to arrive after the order was entered and I had to bolus some more Versed.
6. Only had to give Sux once, Pt was clamped down. Little person, though.

Success so far.

Precedex is great for awake FOI.

There is no shame in a PGY1 calling for help before inducing apnea in an anticipated difficult airway situation.