Tracheotomy in the morbidly obese patient.

Tracheotomy in the morbidly obese patient (weight more than 130 kg) is a difficult procedure. Because of the thickness of the anterior part of the neck and the redundant chin, most commercially available cannulas are inadequate. A custom-made tube is designed by splitting an endotracheal tube along its longitudinal axis and bending the split sides into a T shape. A modification of the available cannulas is proposed to make them suitable for the morbidly obese patient: they should be longer and straighter toward the external opening and an optional extension should be provided to bypass the double chin.