A morbidly obese patient is considered at increased risk of pulmonary aspiration during induction of anesthesia because of delayed gastric emptying and the possibility of difficult airway management. Therefore H2 blockers given the evening before (if possible) and the morning of surgery, preoperative metoclopramide, and oral nonparticulate antacids are in order. Glycopyrrolate is useful for planned fiberoptic intubation. It improves visualization by drying secretions, increases the effectiveness of the topical anesthesia, and decreases airway responsiveness. Opioids and benzodiazepines should be judiciously titrated, using supplemental oxygen and close observation to ensure an awake, appropriately responding patient who can protect his or her own airway.
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