Medical

Morbid obesity / OSA / difficult preoxygenation

Before / During / After / Pitfalls

Before

• Ramp to ear-to-sternal-notch; head-up positioning.
• Use PEEP/NIV/HFNC strategy as appropriate; desaturation occurs quickly.
• Stage longer equipment/redundant oxygenation/rescue plan.

During

• Maintain apneic oxygenation if possible.
• Optimize view with position and external laryngeal manipulation.
• Be ready for two-hand BVM, adjuncts, and SGA rescue.

After

• Use appropriate PEEP, recruitment strategy, and sedation.
• Confirm tube depth carefully; habitus can mislead.
• Plan safe transport with oxygen reserve.

Pitfalls

• Flat positioning.
• No PEEP during preoxygenation.
• Assuming “large patient” only changes ETT size.