Can positioning alter the success of endotracheal intubation in obese?

1. The position of the patient during laryngoscopy is an important factor determining the success of endotracheal intubation. In the present study, the authors have not specified the position of the obese patients while attempting laryngoscopy and endotracheal intubation. The use of ramped position has shown to improve the laryngoscopic view and intubation success rate in comparison to the standard sniffing position in obese patients.2 Neligan et al. in their study showed that OSA does not form a risk predictor for DI in morbidly obese patients in ramped position.3 2. Contrary to the statement by the authors we feel, that the risk factors for difficult mask ventilation and DI are quite different. Modified Mallampatti, neck circumference, thyromental distance and restricted jaw mobility form risk factors for difficult intubation in obese patients.4 While increased body mask index (BMI) and history of OSA has been shown to have correlation with difficult mask ventilation.5 Therefore we feel that a mention of the positioning for endotracheal tube is an important aspect of this study, which can affect the results of the study.