Abstract
A 26-year-old female (ASA 2E), weight 260 lbs., height 5′6″, and BMI 43, is scheduled for an emergency appendectomy. She has a class 3 airway but tells you that she has a previous history of a traumatic and difficult endotracheal intubation. She is otherwise healthy and takes no medication. She refuses a regional block, as she has a lot of back problems. You decide on a fiber-optic intubation, but you are fully aware that topical anesthesia and sedation must be kept to a minimum in an attempt to maintain the patient’s protective laryngeal reflexes and decrease the likelihood of gastric aspiration.
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