Background and Goal of Study: 
Fiberoptic intubation (FOI) is now performed very infrequently in morbidly obese (MO) patients undergoing elective weight loss surgery (WLS). Prior to the introduction of videolaryngoscopy, the need for FOI had been estimated at 5-10% [1]. Since then others have estimated the need for FOI in MO to be in the 1-5% [2]. The objectives of this study were to review literature for predictors of DA in MO, report its described management and comment on the pharmacology of MODA.
Materials and methods: 
Using specific keywords for predictors, management and pharmacology of Difficult Airway (DA) management in Morbid Obesity (MO), we performed a search of peer reviewed literature search. Using expert opinion, we sought to develop consensus for a DA prediction rule specific to MO. We then revised and redeveloped an existing DA algorithm for anticipated difficulty and customized it with modalities specific to MO. 
Results and discussion: 
We summarize the findings of our literature search for predictors of Difficult Airways in MO in Table 1. Based on our literature search and expert opinion, we present a DA algorithm for MO in Figure 1. The pharmacology of MODA, requires the appropriate use of short acting drugs, titrated to the desired effect for the MODA.
In the general population, MO was/ is frequently identified as a predictor of anticipated DA [1]. Now extensive experience in WLS suggests that in MO other predictors are required to identify patients requiring advanced airway management strategies [3]. Conventional DA algorithms suggest that supraglottic devices and surgical airways are both effective ´rescue´ techniques in certain situations where an unanticipated DA is encountered [4]. Experience in MO suggests that alternative management strategies are required in MODA [5]. Also important is the choice, dose and technique of drugs administered during DA management [6]. The avoidance of succinylcholine and judicious use of propofol, remifentanil and/ or dexmedetomidine can improve the safety, success and outcomes in MODA. 
Conclusion(s): 
We propose a simple algorithm that incorporates the predictors and management of the MODA. While further research and expert opinion are required to standardize the MODA, this preliminary work may be an important first step in this direction. 
References: 
1.	Hagberg CA 2009. 
2.	Caldiroli D 2011. 
3.	Sheff SR 2013. 
4.	Frerk C 2015. 
5.	Eipe N 2014. 
6.	Cattano D 2012.

Predicting (and managing) the morbid obesity-difficult airway (MODA)