The Problem State

The Obesity Epidemic Complicates Airway Access and Management During Surgery

More than one third of Americans are obese which can complicate airway care during surgery. To facilitate airway management, research has concluded it is best to elevate the patient’s upper body, head, and neck. When the patient’s external auditory meatus lies in the same horizontal plane as the sternal notch, the airway axes are beginning to align. With the head and neck elevated above the chest and abdomen, the airway is easier to work with. The weight of the patient’s abdomen is falling away from the diaphragm and less positive airway pressure is required to mask ventilate prior to intubation.

The head elevated laryngoscopy position (H.E.L.P.) or ramped position has been shown to improve pre-oxygenation tension prior to induction of anesthesia. This increases the desaturation safety period post induction. According to studies: “Pre-oxygenation is more effective in the 25-degree head-up position than in the supine position in severely obese patients.”

Creating a Stable Ramp for Obese Patients

While achieving the ramped position is possible by placing multiple pillows or blankets under the patient, Dr. Troop concluded that this makeshift approach did not reliably ramp the patient nor did it create a stable platform to support airway management during surgery. To address the need to ramp his obese patients quickly and easily, he designed The Troop Elevation Pillow (TEP). This position helps obese patients to breathe more easily. In other words the TEP is good for the patient. Further, the TEP facilitates all methods of airway management (DL, VL, LMA) by aligning the airway axes. The use of The Troop Pillow is featured in anesthesia textbooks as well as numerous national and international publications.

Craig Troop, MD

Dr. Craig Troop has been in practice for over 40 years. He is an anesthesiologist in the Dallas, Texas area and a member of the US Anesthesia Partners (USAP) group. He has lectured extensively across the USA and Canada on the topic of properly positioning the obese patient for airway management.
Craig Troop, MD

Troop Elevation Pillow

View Solution

Download the paper:

A simple positioning solution for Airway Management of Obese / OSA patients.

In the following videos, Dr. Troop reviews the problem, how to address the problem, and how to successfully use the Troop Elevation Pillow.

Dr. Craig Troop shares why the standard supine position used for intubating a larger patient is not optimal.

Learn how Dr. Craig Troop uses the Troop Elevation Pillow specially designed to achieve the ramped position for intubation of a larger patient.

Dr. Craig Troop shares best practice techniques to properly position the patient on the Troop Elevation Pillow.