This retrospective study compared data from 17 patients with severe obesity (body mass index ≥35 kg/m2) who underwent intubated GA for dental treatment. Researchers examined data related to ventilation (P(A-a)DO2) and oxygenation (P/F ratio) in patients when they were in either the ramped or semi-Fowler positions. The ramped position was defined as the torso being elevated to approximately 30°, with the shoulders raised more and the head lowered so that the ear and sternum were horizontally aligned. The semi-Fowler position was defined as the torso being elevated to approximately 30° and the head and back aligned on the chair back.
In reviewing the patient data, Yoshimoto et al. found no significant differences in patient demographics or anesthetic duration during the procedures. All procedures were also uneventful. The researchers did find that mean ventilation (P(A-a)DO2) was significantly lower in the ramped group (168.83 [54.18] mm Hg) than in the semi-Fowler group (273.33 [39.72] mm
Hg); the mean oxygenation (P/F ratio) was significantly higher in the ramped group (354.44 [88.88]) than in the semi-Fowler group (225.40 [67.49]).
These results indicate that the ramped position was better for patients with severe obesity to maximize pulmonary gas exchange and oxygenation during GA that included mechanical ventilation. Given the results, Yoshimoto and colleagues conclude, “These findings suggest that the ramped position, which has previously been shown to improve mask ventilation and intubation in patients with obesity, may also contribute to more appropriate alveolar gas exchange during the maintenance of general anesthesia. The ramped position is recommended when managing patients with severe obesity during general anesthesia.”
Full text of the article, “Ramped Position Improves Oxygenation During
Mechanical Ventilation for Patients With Severe Obesity,” Anesthesia Progress, Vol. 72, No. 2, 2025, is now available at: www.anesthesiaprogress.org
About Anesthesia Progress
Anesthesia Progress is the official publication of the American Dental Society of Anesthesiology (ADSA). The quarterly journal is dedicated to providing a better understanding of the advances being made in the science of pain and anxiety control in dentistry. The journal invites submissions of review articles, reports on clinical techniques, case reports, and conference summaries. To learn more about the ADSA, visit: https://www.adsahome.org
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