We read with interest the article by Cumberworth et al. [1]. While the focus has obviously centred on the key finding that the “incidence of serious airway complications is at least as high as NAP4,” there is another area that should be highlighted.

The authors found that patients living with obesity were over-represented in the group suffering airway complications, with a case to activity ratio of 2.6 in patients with a BMI > 30. This group was also over-represented in the NAP4 study [2], where 40% of all cases had a BMI > 30. In addition, the study by Shaw et al. [3] showed minor airway events are more common in the obese population.

This goes against the general perception and common teaching that patients with obesity do not have difficult airways per se. As a result, we must question why this population suffer a higher proportion of both major and minor airway complications.

Is it poor planning and lack of anticipation of difficult anaesthetic management? Is it assuming that these airways will be straightforward, and not having back up plans in place? Is it the physiological changes leading to more rapid oxygen desaturation causing time pressure and introducing a degree of panic? Is it a lack of adequate training in this population? These are not easy questions to answer.

At the Society for Obesity and Bariatric Anaesthesia (SOBA), we are keen to ensure best education and best practice for anaesthetic management in patients living with obesity and welcome support from other interested groups in order to improve the situation.

我们感兴趣地阅读了 Cumberworth 等人的文章。[ 1 ]。虽然重点显然集中在“严重气道并发症的发生率至少与 NAP4 一样高”这一关键发现上，但还有另一个领域需要强调。

作者发现肥胖患者在气道并发症组中的比例过高，BMI > 30 患者的病例活动比为 2.6。该组在 NAP4 研究中的比例也过高 [ 2 ]，其中 40% 的病例的 BMI > 30。此外，Shaw 等人的研究。[ 3 ] 表明轻微气道事件在肥胖人群中更为常见。

这违背了肥胖患者本身没有困难气道的普遍看法和普遍教导。因此，我们必须质疑为什么这一人群遭受重大和轻微气道并发症的比例更高。

是计划不周和缺乏对困难麻醉管理的预期吗？是否假设这些航空公司将是直截了当的，并且没有备份计划？是生理变化导致更快的氧饱和度下降导致时间压力并引入一定程度的恐慌吗？在这个人群中是否缺乏足够的培训？这些都不是容易回答的问题。

在肥胖和减肥麻醉协会 (SOBA)，我们热衷于确保对肥胖患者进行麻醉管理的最佳教育和最佳实践，并欢迎其他感兴趣团体的支持以改善这种情况。