Awake video laryngoscopy and tracheal intubation in a super morbidly obese critically ill patient with a physiologically difficult airway
Kurian, Davis Bansal, Prachi Edwards, Cassia George, Sam Ravindran, Manoj
Kurian, Davis
Bansal, Prachi
Edwards, Cassia
George, Sam
Ravindran, Manoj
Abstract
Standard airway management in deteriorating super morbidly obese patients can lead to cardiovascular collapse because of their poor physiological reserves. In this report, we describe a case of awake tracheal intubation in a super morbidly obese patient who was rapidly deteriorating in the intensive care unit. The patient was approached as having a physiologically difficult airway, and therefore, we accounted for the four Hs: hypoxia, hypotension (systemic), hydrogen ions (metabolic acidosis) and hypertension (pulmonary). To optimise these patient factors, we administered pre- and apnoeic oxygen through a high-flow nasal cannula to prevent hypoxia. Awake video laryngoscopy was performed to avoid cardiovascular compromise that could arise from using sedation/induction agents. Intravenous metaraminol was run in parallel to fluid support to reduce cardiovascular compromise risks and worsening acidosis. Approaching the patient as an anatomically and physiologically difficult case provided a safe technique for securing an extremely challenging airway.
Affiliations
George Eliot Hospital NHS Trust, Nuneaton
Date
2026-04-10
Type
Article
Collections
Citation
Kurian D, Uthayanan L, Bansal P, Edwards C, George S, Ravindran M. Awake video laryngoscopy and tracheal intubation in a super morbidly obese critically ill patient with a physiologically difficult airway. BMJ Case Rep. 2026 Apr 10;19(4):e269211. doi: 10.1136/bcr-2025-269211.