CICO in morbid obesity and anatomical distortion
Jan 08, 2026
CICO events are rare, but when they occur in patients with morbid obesity or altered neck anatomy, the challenge escalates quickly. In perianaesthesia, these patients are increasingly common. Understanding how body habitus and distorted anatomy affect airway rescue helps teams act earlier and more decisively.
Morbid obesity changes airway physiology. Reduced functional residual capacity means oxygen reserves are smaller and desaturation happens faster. Soft tissue bulk around the neck can obscure landmarks, limit neck extension, and make mask ventilation and supraglottic airway placement less effective. Anatomical distortion from tumours, previous surgery, radiotherapy, infection, or trauma further complicates both intubation and emergency front of neck access.
In a CICO situation, delay is dangerous. The eFONA guidance highlights that landmark identification can be unreliable in obesity and distorted anatomy, and that reliance on palpation alone may fail. Early declaration of CICO and a clear plan for emergency front of neck access are critical when oxygenation is deteriorating.
Key considerations include:
🔵Rapid desaturation is expected in morbid obesity
🔵Neck landmarks may be difficult or impossible to feel
🔵Early CICO declaration supports timely action
🔵Scalpel based eFONA techniques are more reliable than narrow bore cannulae
🔵Team role clarity reduces hesitation under pressure
For perianaesthesia nurses, preparation makes the difference. Anticipating difficulty, positioning patients optimally, knowing where airway rescue equipment is stored, and supporting early escalation all contribute to safer outcomes. Clear communication when oxygenation is failing helps the team move forward together.
Clinical insight: In obesity and anatomical distortion, CICO arrives faster and looks different. Acting early and prioritising oxygenation saves lives.
Build Knowledge ✅
Improve Safety ✅
References:
PerioperativeCPD. (2024). Emergency front of neck access (eFONA). https://www.perioperativecpd.com/wp-content/uploads/2024/03/eFONA.pdf
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.
Unlock Exclusive Free Content
Join the mailing list. We give too much great content away for free, see what all the fuss is about.
Categories
All Categories abg acid base acidosis acorn adrenaline adrenaline dosing adrenaline in anaphylaxis advanced advancedhaemostats adverse reaction aed agents ahpra ahpra audit airway airway adjuncts airway assessment airway emergency airway filter airway management airway mass airway rescue airway trauma airwaylifeline airwayoptimisation algorithm allergy allergy testing als als aftercare alsmedications amiodarone anaesthesia anaesthetic anaesthetic machine anaesthetics analgesia anaphylactoid anaphylaxis anaphylaxis aftercare anaphylaxis diagnosis anaphylaxis differential diagnosis anaphylaxis management anaphylaxis triggers anatomy antibiotics antiemetic anzaag anzcor apnoea arrest arterial blood gas arterial line arterial line complications arterial line errors arterial lines arterialcannulation arteriallines asa article asl aspiration aspiration risk assessing pain assessment atypical anaphylaxis awareness bag mask ventilation behaviours of concern beta blockers biphasic anaphylaxis bis bispectral index blade bleed bleeding bleeding airway block blocks blood blood glucose blood pressure blood pressure monitoring blood products blood safety bluey boundaries breathing circuit bronchoscopy bronchospasm burns calcium cannula technique cannulation capnography cardiac arrest cardiac collapse cardiac output cardiac surgery cardiovascular causesofcardiacarrest cell saver central venous catheter centralvenouscatheter cerebral oximetry checklist checklists chlorhexidine cico circadian cycle circuit classification climate climate change clinicaldecisionmaking clinicalpractice closed loop communication co2 coagulation coagulopathy cognitive aid colonoscopy communication complications compression rates compressions contaminant coolinginmh core body temperature cpd cpr cricoid pressure cricothyrotomy crisis crisis resource management critical incident criticalbleeding cross matching cura cvc cvc complications dantrolene debriefing decisions defibrillation dental surgery depth of anaesthesia diabetes diagnostics differential diagnosis difficult airway documentation drug errors drug safety drugs ecg education educator emergence delirium emergency emergency management emotional intelligence end tidal carbon dioxide endoscopy endotracheal tubes ent entropy environment epidural anaesthesia equipment ercp error ett exchange catheter exercise fasting feedback ffp fluid balance fluid resuscitation fluid therapy fona formal diagnosis fracture fixation principles fracture patterns frailty ga gas gas analysis gastroscopy general anaesthetic gloves glp-1 ra glp-1 receptor agonists glp-1ras goals of care haemodynamic haemoglobin haemorrhage haemostasis haemostatic haemostaticagents haemostats handle handover hazard health heart rate hemodynamics hereditarydisorder high flow high risk hot debrief human factors hypnosis hypoglycaemia hypotension hypothermia hypoxia icu immune response incomplete reversal induction infection infection control inotrope inotropes intravenous intravenous cannulation intubation invasive blood pressure monitoring invasive device invasivebloodpressuremonitoring iv induction ketamine laryngeal mask laryngectomy laryngoscope laryngospasm last leadership learning lifelines lma local anaesthetic long term venous access major surgery malignanthyperthermia mallampati mask ventilation massive transfusion massive transfusion protocol mast cells mean arterial pressure medications mh mhtesting mls monitoring movement muscle relaxants neck surgery nep nerve blocks nerve monitoring neuraxial neuroanaesthesia neuromonitoring neuromuscular blockade neuromuscular junction neurophysiology neurosurgery neurosurgerynursing neurovascularcare neurovascularsurgery nmt non-invasive blood pressure non-shockable rhythms nurse burnout nurse education nurse wellbeing nurselife nursing nursingeducation nutrition obstetric obstetrics anaesthesia obstruction operatingroom operatingroomnursing opioid opioids orthopaedic biology orthopaedic nursing ot oxygen oxygenation ozempic pacu paediatric paediatric anaesthesia paediatric t piece paediatrics pain pain management partnership passive patient safety patientbloodmanagement patientsafety perianaesthesia nurse educator perioperative perioperative orthopaedics perioperativeeducation perioperativenurse perioperativenursing physiology pipeline platelets ponv positioning post op bleed post operative pregnancy preoperative preoperative care preoxygenation preparedness primary survey professional development protocol psychological safety publications pulmonary radiation rapid sequence induction recognition recovery recovery issues recovery room emeregencies refractory anaphyalxis refractory hypotension regionalanaesthesia renal resilience resources respiratory resuscitation reversal rotem safe apnoea time safety scalpel scalpel technique scoutnurse scrub scout nursing scrubnurse scrubscoutconcepts sedation seldinger shared airway shock shockable rhythms signs of anaphylaxis simulation skin prick testing sleep specialty anaesthesia spinal spinal anaesthetic sterile procedures stress reduction surgery surgical surgical considerations surgical safety checklist surgicalcare surgicalphysiology surgicalpractice surgicalsafety surgicalteamwork surgicaltechniques systemic tachycardia teaching styles team time-out teamwork techniques teg temperature testing therapies tonsillectomy topical topicalhaemostats tracheostomy training tranexamic acid transfusion transfusion reaction trauma treatment tryptase ultrasound ultrasoundprobes vascular surgery vasopressor ventilation vf videolaryngoscope volatileagents vortex approach vt waste wellbeing whole blood workshop