Mashour et al identified risk factors associated with difficult laryngoscopy in a morbidly obese patient. These can help to identify a patient who requires more aggressive management during the procedure. The authors are from the University of Michigan and Massachusetts General Hospital.


Patient selection: morbidly obese with body mass index >= 40 kg per square meter


Risk factors for difficult laryngoscopy:

(1) extended Mallampati score (EMS) III or IV

(2) diabetes mellitus



• The extended Mallampati score is performed with the head in extension rather than in the neutral position. This reduces the number of false positive interpretations, improving its performance.


Many morbidly obese patients can safely undergo laryngoscopy without difficulty.


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