Medical

Morbid obesity / OSA hypoxemic airway

Before / During / After / Pitfalls

Before

• Ramped/head-up position, ear-to-sternal-notch alignment, and aggressive preoxygenation/PEEP.
• Plan two-person BVM, adjuncts, longer preoxygenation if possible, and backup SGA/cric path.
• Dose and ventilator settings require deliberate PBW/actual-weight distinctions.

During

• Avoid losing position after meds.
• Use apneic oxygenation when appropriate and skilled first attempt.
• Confirm placement; tube dislodgement and derecruitment risks are high.

After

• Use PBW for VT, adequate PEEP/FiO2, and early recruitment strategy per protocol.
• Secure tube well and reassess after movement.
• Sedation/analgesia and hemodynamics review.

Pitfalls

• Flat positioning.
• Underpowered preoxygenation.
• Using actual body weight for tidal volume targets.