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Outpatient Surgery E-Weekly

Malpractice Verdicts Often Favor Physicians

Physicians come out on the winning end of 80% of malpractice claims that end in jury verdicts, according to researchers at Massachusetts General Hos...

Study: CT Colongraphy Effective in Finding Polyps

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Wrong-Site Prevention Video Shows the Right Way

Wrong-site, wrong-patient and wrong-procedure surgery must be prevented at all costs. The 3 steps of the Joint Commission's Universal Protocol make ...

Archive > October, 2011 Vol. XII, No. 10

Airway Strategies for Heavier Patients

Difficult intubations are just one of the many airway challenges of treating the obese.

Daniel Cook, Managing Editor

It took anesthesiologist Becky Wright, MD, 5 attempts to intubate Mae Ellen Williams, a 5-foot-2-inch, 215-pound patient who went to Baptist Memorial Hospital in Memphis, Tenn., for a laparoscopic cholecystectomy. According to court records, the procedure was uneventful. But after being extubated, Ms. Williams was unable to breathe on her own. Her vital signs became undetectable. She slipped into a coma and died 2 years later. A lawsuit filed by the woman's family accused Dr. Wright of failing to perform an awake intubation and of making more than 3 attempts at inserting the endotracheal tube, which allegedly led to airway swelling and subsequent ventilation difficulties. Did Dr. Wright follow the standard of care? Was she prepared to handle a difficult airway? That argument would play out in court — a judgment on a technicality was in Dr. Wright's favor — but what's important here is the underlying clinical lesson. "With proper planning, obese patients don't necessarily have more difficult airways than the general population," says William Loder, MD, of the department of anesthesiology at Geisinger Medical Center in Danville, Pa. "But if you don't plan ahead and can't intubate them, you'll be in a world of trouble in a hurry."

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