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To optimise these patient factors, we administered pre- and apnoeic oxygen through a high-flow nasal cannula to prevent hypoxia. Awake video laryngoscopy was performed to avoid cardiovascular compromise that could arise from using sedation\/induction agents. Intravenous metaraminol was run in parallel to fluid support to reduce cardiovascular compromise risks and worsening acidosis. Approaching the patient as an anatomically and physiologically difficult case provided a safe technique for securing an extremely challenging airway.<\/jats:p>","DOI":"10.1136\/bcr-2025-269211","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:30:20Z","timestamp":1775842220000},"page":"e269211","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Awake video laryngoscopy and tracheal intubation in a super morbidly obese critically ill patient with a physiologically difficult airway"],"prefix":"10.1136","volume":"19","author":[{"given":"Davis","family":"Kurian","sequence":"first","affiliation":[{"name":"Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9310-4607","authenticated-orcid":false,"given":"Leshanth","family":"Uthayanan","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prachi","family":"Bansal","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassia","family":"Edwards","sequence":"additional","affiliation":[{"name":"Physiological Sciences, George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"George","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Ravindran","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"2026062608153903000_19.4.e269211.1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer058"},{"key":"2026062608153903000_19.4.e269211.2","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.5811\/westjem.2015.8.27467","article-title":"The Physiologically Difficult Airway","volume":"16","author":"Mosier","year":"2015","journal-title":"WestJEM"},{"key":"2026062608153903000_19.4.e269211.3","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu373"},{"key":"2026062608153903000_19.4.e269211.4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1365-2044.2011.06979.x","article-title":"Awake videolaryngoscopy-assisted tracheal intubation of the morbidly obese","volume":"67","author":"Moore","year":"2012","journal-title":"Anaesthesia"},{"key":"2026062608153903000_19.4.e269211.5","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/0310057X0903700213","article-title":"Video and optic laryngoscopy assisted tracheal intubation--the new era","volume":"37","author":"Thong","year":"2009","journal-title":"Anaesth Intensive Care"},{"key":"2026062608153903000_19.4.e269211.6","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/76.2.284"},{"key":"2026062608153903000_19.4.e269211.7","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31821811ba"},{"key":"2026062608153903000_19.4.e269211.8","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e318183909b"},{"key":"2026062608153903000_19.4.e269211.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-015-3796-z"},{"key":"2026062608153903000_19.4.e269211.10","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000743"},{"key":"2026062608153903000_19.4.e269211.11","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14904"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:19:59Z","timestamp":1782487199000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":11,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,10]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-269211"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269211","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}