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.”