Background

• Patient for biopsy of left lower eyelid, left canthus and nose, right cheek lesion
• Multiple cardiorespiratory comorbidities. Morbid obesity (BMI 59).
• Previous HARD card from 1991 noted with grade 3-4 view, however GA in 2019 with documented grade 2 view with bougie for intubation. 
• Significant anxiety – requesting sedation or GA. 

Issues

• Mode of anaesthesia: sedation or GA

Discussion

• Sedation problematic due to obesity and potential airway compromise with sedation. Compounded by issues with HFNP oxygen (or any supplemental oxygen) being applied given location of lesions, as well as limited access to airway if support is required. Additional problem with O2 and diathermy.

Plan

• General consensus for GA with ETT