Successful intubation position.
Optimal positioning for obese patients with a short neck (especially in obstetrics) is the main predictor of successful intubation.
Potential difficulty in securing the airway in pregnant patients may be due to:
- airway edema
- a full dentition
- large breasts that can obstruct the handle of the laryngoscope in patients with short necks
- increased intra-abdominal pressure
- High risk of regurgitation of gastric contents and acid aspiration syndrome
- Rapid onset of hypoxaemia after induction (FRC reduced by 20%)
- Risk of bleeding from airway manipulation due to coagulopathy in pre-eclampsia.
The enhanced intubation position was introduced by Chevalier Jackson at the beginning of XX century. Dr. Richard Levitan calls this the head-elevated laryngoscopy position (HELP). Also it is called "ramp" position.
Benefits of "HELP":
- Optimises upper airway patency & laryngoscopy view
- Facilitates mask ventilation.
- Extends the safe apnea period
- Shortens time needed with mask ventilation to return to normal oxygen saturation
- Following intubation, it improves the mechanics of ventilation
Technique:
The shoulders and head should be raised enough so that an imaginary horizontal line drawn through the ear canal intersects the xiphoid process. (see the red line in the picture).
Place SEVERAL pillows (rolled blankets or rolled towels) so they form a “ramp” at the head of the bed is ESSENTIAL in managing the obese patient’s airway.
