ABSTRACT

Morbidly obese patients have a very high risk of complications during airway management,
including intubation, caused by changes in airway anatomy. The changes include short and
redundant neck, limited neck extension, and fat accumulation on pharyngeal wall causing
difficulties in laryngoscopy procedure. Many of these patients also suffered from Obstructive
Sleep Apnoea (OSA). OSA together with mechanical and circulation changes in the lungs also
contribute to difficult maintenance and oxygenation process.

Lung separation technique is designed to facilitate thoracic and oesophageal surgery by

maintaining ventilation only in one lung. In morbidly obese patients, this technique may cause
various risks during airway management. In order to lessen the risk, a secured airway is the priority
followed by separation technique using Singe-Lumen Endotracheal Tube (SLT) and Bronchial
Blocker (BB) or other technique using Double-Lumen Endotracheal Tube (DLT).

The prevalence of obesity is increasing worldwide. The fact is, a third of adult populations
in United States are obese and 5-10% of them are morbidly obese. Obesity is diagnosed by a Body
Mass Index (BMI) of > 30 kg/m2, on the other hand, morbidly obese means a BMI of > 35 kg/m2.
Obese patients often have increased gastric volume and acidity, making them prone to aspiration.

Intubation using DLT become more difficult compared to SLT because of its larger
diameter. Thus, the writer hypothesized that it will be easier to do intubation in morbidly obese
patients using SLT followed by BB during elective surgery and one-lung ventilation.