Pentax-AWS airway Scope as an alternative for awake flexible fiberoptic intubation of a morbidly obese patient in the semi-sitting position

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Abstract
For anesthesia induction in a morbidly obese patient with a full stomach, awake flexible fiberoptic bronchoscope (FOB) intubation in the semi-sitting position may be a suitable choice. A new rigid indirect videolaryngoscope, the Pentax-AWS system, has a unique feature of an adjustable built-in monitor and is designed to be used in patients in various positions. However, the efficacy of its use in such situations has not been investigated or reported. We used the Pentax-AWS system for the intubation of a morbidly obese patient (body mass index >50) who was at risk of regurgitation, anticipated difficult intubation, and supine hypotensive syndrome due to inferior vena cava compression by a huge ovarian cyst. The patient was placed in the sitting position during the intubation procedure. The patient's trachea was intubated with the Pentax-AWS by an anesthesiologist positioned at the patient's right and facing her. The Pentax-AWS offered easy intubation under good visualization of the glottic aperture as a consequence of its adjustable integrated monitor, in contrast to difficult intubation with other videolaryngoscopes which require an external monitor. This report illustrates that the Pentax-AWS is useful as an alternative for flexible fiberoptic intubation under these circumstances, as a consequence of its adjustable built-in monitor and integrated tube channel.