Emergency Tracheotomy in Morbid Obesity

Research Article

Austin Surg Case Rep. 2017; 2(2): 1018.

Emergency Tracheotomy in Morbid Obesity

Baltasar A*, Bou R, Bengochea M, Serra C and Pérez N

Clínica San Jorge & Alcoy Hospital, Alcoy, Alicante, Spain

*Corresponding author: Baltasar A, Clínica San Jorge & Alcoy Hospital, Alcoy, Alicante, Spain

Received: June 19, 2017; Accepted: July 17, 2017; Published: July 24, 2017


Introduction: Difficult Intubation (DI) may require Emergency Tracheotomy (ET) to save patient´s life is a rare complication in the Morbidly Obese (MO). Probably it occurs more often than is published.

Methods: Three patients in a series of 1497 patients required ET and they belong to the latter part of our series.

Results: In the three MO the ET was conducted without any technical incident and surgery continued in all of them.

Conclusion: DI should be suspected in the patients before it may occur and endoscopic fiber-optic endoscopic intubation (FEOI) carried out, but if the ET is necessary, surgeons and instruments should be prepared to solve this vital problem.

Keywords: Difficult Intubation; Obesity Emergency Tracheotomy; Impossible Intubation; Impossible Airway


Anesthetic accidents can occur more frequently in the Morbidly Obese (MO). Difficult Intubation (DI) is a rare complication rarely reported in the bariatric literature but frequently in Anesthesiology one because it is a complication of his own specialty. However, a DI patient may need an Emergency Tracheotomy (ET) at the beginning of the surgical procedure to save the patient’s life.

Materials and Methods

From May 1977 to February 2013, 3 patients required an ET among 1497 patients operated on for MO, and they are the cause of this report.

Case 1: 1309

A 44 years-old male patient had a BMI-35with hypertension. Waist/Hip Ratio (WHR)-1.05. After several repeated attempts at intubation by two cooperating anesthetists, the O2 saturation stayed under 55. ET by 3 expert senior surgeons was done and a satisfactory ventilation recovery obtained. We proceed with the planned Sleeve- Forming Laparoscopic Vertical Gastrectomy (SFVG) without incident. Extubation was done on the 3rd DPO. The ET wound closed but re-opened on 10 DPO and second repair was needed. 30 months later his BMI is 26, EBMI (expected BMI) -26, %EBMI-102%, %EWL 84% and %EBMIL 90% (Figure 1).