Use of a positive pressure endoscopic mask to assist with positive pressure ventilation in a morbidly obese patient during fiberoptic intubation: a case report.

Airway management in the morbidly obese, anesthetized patient can be especially challenging. Difficulties in fiberoptic intubation (FOI) can be experienced due to alterations in airway anatomy associated with morbid obesity and the effects of anesthesia. The loss of upper airway muscle tone that occurs during anesthesia compromises the structure of the pharynx, causing a tendency toward airway collapse. This collapsibility can prevent the identification of anatomical structures during FOI, making this advanced airway technique difficult or impossible. The application of positive pressure via endoscopic mask ventilation during FOI can help to stent open collapsible airways and reestablish airway anatomy in morbidly obese patients. Although drawbacks exist, the endoscopic mask may be most effective at accomplishing this goal.