Friday, May 20, 2016

Q: During intubation of a morbidly obese patient via Rapid Sequence Intubation (RSI), neuromuscular blockade (NMB) should be used by calculating (select one)

A) lean body weight (LBW) 
B)  total body weight (TBW) 

Answer: B

Intubation, and particularly emergent intubation can be very tricky in obese patients. Proper preparation with positioning, pre-oxygenation, rescue back-up, available equipments and proper dosing of medications are keys to a success. During intubation of an obese patient via RSI in an obese patient, induction agents are preferred to be calculated by lean body weight (LBW), and neuromuscular blockers with the calculation of total body weight (TBW).

* Lean body weight is many times confused with ideal body weight (IBW). They can be markedly different in an obese patient. Pharmacy or online tools usually have quick calculators to provide medicine dosing depending either on IBW or LBW.

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