Airway management in obese patients has to consider that mask ventilation (DMV) risk is increased and difficult tracheal intubation (DTI) risk may be increased too.

In obese patients, is essential to prevent early arterial oxygen desaturation related to a reduced functional residual capacity (FRC), atelectasis formation during anesthetic induction and after tracheal intubation, because oxygenation maintenance is the cornerstone of the airway management of the obese patient.

Endotracheal intubation is usually required to allow unrestricted surgical approach. The Macintosh laryngoscope is the standard method. However, sometimes this technique is ineffective and poorly tolerated by the obese patient.

The Totaltrack™ (MedComflow S.A., Barcelona, Spain) is a hybrid device, between a supraglottic airway and a videolaryngoscope with an anatomically shaped blade. It allows fibreoptic visualization of the larynx for tracheal intubation and was developed to aid both ventilation and tracheal intubation, at the time of anticipated and unanticipated difficult airway management.

However, despite its use in clinical practice, there are no comparative studies regarding direct laryngoscopy in obese patients.

Inclusion Criteria:

• BMI > 30.
• ASA 1-3
• Scheduled surgeries that require orotracheal intubation.
• General anesthesia with neuromuscular relaxation before intubation.
• Patients who sign informed consent.

Exclusion Criteria:

• ASA 4
• Difficult airway already known.
• Alterations of airway documented, with previous tracheostomy or involve anatomical alterations.
• General anesthesia that not require orotracheal intubation or neuromuscular relaxation.
• Symptomatic gastro-esophageal reflux.
• Lap-Band carrier.
• Allergy medications to use.
• Urgent surgery.