Return to Spontaneous Ventilation Can Be Life-Saving

Marc A. Pressman, MD

To the Editor:

I read with considerable concern the article titled, "Difficult Intubation in the Obese Patient," (APSF Newletter, Winter 2005-2006 Issue, Page 83). While it is true that positioning is extremely important in airway management in the obese patient, I feel that the real lesson in this case is being overlooked. In an obese patient for an ELECTIVE procedure, when difficulty with visualization/mask ventilation is encountered, the goal should be to return the patient to spontaneous ventilation with a clear airway as soon as possible, not insertion of an ETT! I suspect that in this case quite a few attempts at intubation were tried with various devices before the airway was irretrievably lost. With succinylcholine, return to spontaneous ventilation should occur fairly rapidly in most cases, and the procedure should have been canceled and the patient awakened. Better to come back another day with such a patient, perhaps for an awake intubation under appropriate sedation, than to lose him in trying to be heroic.

Marc A. Pressman, MD
Surgicenter of Baltimore
Owings Mills, MD